Occupational history quality in patients with newly documented, clinician-diagnosed chronic bronchitis.
BACKGROUND
Approximately 15% of cases of COPD, including chronic bronchitis, is attributable to occupational exposures. An occupational history is essential to identify exposures responsible for work-related chronic bronchitis.


METHODS
We conducted a structured retrospective analysis of the medical records of veterans, 18 to 70 years of age, newly diagnosed with chronic bronchitis in order to achieve the following: (1) to assess the quality of documented occupational histories; and (2) to characterize the management of patients with a history of exposure to a potentially hazardous respiratory substance. We also analyzed occupational exposure data reported by patients on a structured questionnaire.


RESULTS
Sixty patients were included in the final analysis. A total of 6,150 notes were reviewed. Occupational status was documented in the records of 54 patients (90%). A description of occupational duties was recorded in 32 records (53%), and work exposure data in 26 records (43%). Clinicians concluded that occupational exposures potentially contributed to chronic bronchitis in three patients (5%). A recommendation for exposure avoidance was documented for six patients (10%). On the questionnaire, most patients reported a history of occupational exposure to respirable substances and symptoms of cough and/or shortness of breath.


CONCLUSIONS
Details about job duties and occupational respiratory exposures were documented in the records of approximately half of patients with newly diagnosed chronic bronchitis. Patient self-reports of occupational exposures and respiratory symptoms were common. A determination that occupational exposures contributed to chronic bronchitis was rare. Few patients were counseled to take measures to avoid occupational exposures. Work-related chronic bronchitis may be incompletely assessed and undermanaged by clinicians.
Kuschner
Ware G
WG
Pulmonary Section, US Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. Electronic address: ware.kuschnermd@va.gov.
Hegde
Shainy
S
Pulmonary Section, US Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
Agrawal
Madhuri
M
Pulmonary Section, US Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D029481:Bronchitis, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004651:Employment; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019570:Inhalation Exposure; D038801:International Classification of Diseases; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States; D017132:Workplace; D055815:Young Adult