title: Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures?
abstract: BACKGROUND
  Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies.
  
  
  OBJECTIVE
  The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare workplace exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC.
  
  
  METHODS
  SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC.
  
  
  RESULTS
  The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician.
  
  
  CONCLUSIONS
  The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Olim
authors.forename: Denis
authors.initials: D
authors.lastname: Bégin
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
authors.forename: André
authors.initials: A
authors.lastname: Cartier
authors.forename: Michel
authors.initials: M
authors.lastname: Gérin
authors.forename: Catherine
authors.initials: C
authors.lastname: Lemière
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D054538:Occupational Health Physicians / Q000706:statistics & numerical data*; D017132:Workplace