Use of objective testing in the diagnosis of work-related asthma by physician specialty.

Ann Allergy Asthma Immunol. 2006 Oct;97(4):546-50. Curwick CC, Bonauto DK, Adams DA. Safety & Health Assessment & Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington 98504-4330, USA.

BACKGROUND: Although early and accurate diagnosis of work-related asthma is critical to avoid unnecessary medical, legal, social, and economic consequences, little is currently known about the diagnostic practices of physicians treating workers with work-related asthma.

OBJECTIVE: To characterize the use of objective diagnostic testing for work-related asthma by physician specialty.

METHODS: A cross-sectional, descriptive, comparative evaluation was conducted of 301 workers' compensation claimants with work-related asthma.

RESULTS: A few claimants (36.9%) were treated by specialists in work-related asthma (allergists, pulmonologists, or occupational medicine physicians) either initially or through the course of their claim. Workers with occupational asthma were more likely to have seen a specialist than those with work-aggravated asthma (47.9% vs 23.0%; P < .001). Less than half of the claimants with work-related asthma (43.2%) had received an objective evaluation of pulmonary function, through either pulmonary function testing or testing for reversible airflow limitation, for the evaluation of their work-related asthma. Claimants treated by specialists were significantly more likely to have received diagnostic testing during evaluation of their disease than those treated solely by generalists (82.9% vs 20.0%; P < .001).

CONCLUSIONS: The results of this study point to the lack of appropriate diagnostic care received by workers with work-related asthma. Physicians who may have questions about diagnostic procedures should consider referral to a specialist. The development of referral networks for work-related asthma may be warranted and should be explored.

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