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Use of Specific Inhalation Challenge in the Evaluation of Workers at Risk for Occupational Asthma^*

A Survey of Pulmonary, Allergy, and Occupational Medicine Residency Training Programs in the United States and Canada

^* From the Department of Medicine (Ms. Carter and Dr. Banks), Section of Pulmonary and Critical Care Medicine, West Virginia University School of Medicine, Morgantown; and National Institute for Occupational Safety and Health (Drs. Ortega and Weissman), Morgantown, WV.

Correspondence to: Hector G. Ortega, MD, ScD, National Heart, Lung, and Blood Institute, Division of Lung Diseases, Two Rockledge Centre, 6701 Rockledge Dr, Ste 10018, Bethesda, MD 20892-7952

Study objectives: To document the current practice of occupational asthma (OA) diagnosis and use of specific inhalation challenge (SIC).

Design, setting, and participants: A survey evaluating the current practice of SIC was mailed to 259 residency training programs in adult pulmonary diseases, allergy and immunology, and occupational medicine accredited in the United States and Canada during the year 2000.

Results: Forty-six percent (123 of 259 programs) participated. Ninety-two programs reported that patients with OA were seen during the previous year, 15 programs reported that SIC had been performed, and 10 programs reported that patients had been referred to other sites for SIC. A total of 259 patients underwent SIC. No unexpected adverse reactions were reported. Forty-one programs reported that they had been willing to undertake SIC but were unable to do so. The most common barriers cited were lack of availability of SIC within the evaluating institution, inability to locate a site for referral, concerns about reimbursement, and lack of an appropriate diagnostic reagent for use in SIC. Seventy-four programs indicated that SIC was useful, and 34 programs included training in the use of SIC was part of the residency curriculum.

Conclusion: Although SIC is considered the "gold standard" for objective documentation of OA, the test is performed in only a few institutions in the United States and Canada. Many institutions indicate that SIC is not available, even when desired for patient management. Only a minority of participating residency training programs include SIC as a formal part of the training curriculum.

Key Words: occupational asthma • specific inhalation challenge • residency training program

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