title: Does the medical diagnosis of occupational asthma coincide with the legal diagnosis?
abstract: OBJECTIVE
  The incidence of occupational asthma (OA) is increasing worldwide. In this study, we first aimed to document the rate of diagnosis of OA among patients who were referred to our clinic from the Social Security Institution and the factors that affected diagnosis; secondly, we aimed to assess the consistency of the medical and legal diagnoses.
  
  
  METHODS
  The study involved 132 consecutive patients who were referred to our clinic for the evaluation of OA between 2010 and 2015. Detailed workplace history, the tools used in the diagnosis such as peak expiratory flow (PEF) monitoring and bronchial provocation tests, and the final medical diagnosis were recorded from case files.
  
  
  RESULTS
  Asthma was diagnosed in 75% (n = 99) of the patients. Among them, 22.2% were diagnosed as having OA. The diagnosis was confirmed by serial PEF measurements, non-specific bronchial hyperreactivity assessment or both of the tests both at work and off-work periods. OA diagnosis was mostly established in active workers (72.7%). The legal diagnosis period was completed in 54.5% of these 22 patients, and 50% (n = 11) were officially diagnosed as having OA with a 91.6% concordance with medical diagnosis.
  
  
  CONCLUSIONS
  This study verifies the importance of diagnosing asthma correctly as a first step in the evaluation of OA. Diagnostic tests other than specific provocation tests could be preferential in patients who still work in the same field. We believe that cooperation with the patient's occupational physician and adequate recognition of the work environment will improve the consistency of legal and medical diagnoses.
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Çelebi Sözener
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Ömür
authors.initials: Ö
authors.lastname: Aydın
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Yavuz Selim
authors.initials: YS
authors.lastname: Demirel
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Şadan
authors.initials: Ş
authors.lastname: Soyyiğit
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Pamir
authors.identifier: http://orcid.org/0000-0002-0844-6352
authors.initials: P
authors.lastname: Çerçi
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Reşat
authors.initials: R
authors.lastname: Kendirlinan
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Sevim
authors.initials: S
authors.lastname: Bavbek
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Gülfem Elif
authors.initials: GE
authors.lastname: Çelik
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Zeynep
authors.identifier: http://orcid.org/0000-0003-4624-4599
authors.initials: Z
authors.lastname: Misirligil
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Betül Ayşe
authors.initials: BA
authors.lastname: Sin
authors.affiliation: b Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey.
authors.forename: Arif
authors.initials: A
authors.lastname: Keleşoğlu
authors.affiliation: a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey.
authors.forename: Dilşad
authors.initials: D
authors.lastname: Mungan
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000331:legislation & jurisprudence*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Compensation; medicolegal diagnosis; occupational asthma; specific provocation testing