Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (2)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shofer, S.
Right arrow Articles by Kuschner, W. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shofer, S.
Right arrow Articles by Kuschner, W. G.
(Chest. 2006;130:455-462.)
© 2006 American College of Chest Physicians

Quality of Occupational History Assessments in Working Age Adults With Newly Diagnosed Asthma*

Scott Shofer, MD, PhD; Brian M. Haus, MD and Ware G. Kuschner, MD, FCCP

* From the Department of Pulmonary, Allergy, and Critical Care Medicine (Dr. Shofer), Duke University School of Medicine; Pulmonary Section (Dr. Kuschner), Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; and Division of Pulmonary and Critical Care (Dr. Haus), Stanford University School of Medicine, Stanford, CA.

Correspondence to: Ware Kuschner, MD, FCCP, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Pulmonary Section, Mail Stop 111 P, Palo Alto, CA 94304; e-mail: ware.kuschnermd{at}va.gov

Abstract

Background: Approximately 10 to 15% of new-onset asthma in adults is attributable to occupational exposure. The occupational history is the most important instrument in the diagnosis of occupational asthma (OA).

Study objectives: To assess the quality of occupational histories obtained by health-care providers and to measure the prevalence of clinician-diagnosed OA in a population at elevated risk for OA.

Setting: An academic US Department of Veteran Affairs medical center.

Study population: One hundred ninety-seven adults (age range, 18 to 55 years) with newly diagnosed asthma who had completed pulmonary function testing (PFT) and a structured respiratory health questionnaire.

Measurements: We conducted a structured retrospective comparison of occupational respiratory health history documented by clinicians with data documented by patients on a structured questionnaire. We analyzed PFT results to assess physiologic impairment. We also conducted a structured examination of the actions taken by health-care providers based on their occupational history assessments.

Results: Patient self-reports of respiratory exposures and symptoms were common. A job title was documented by one or more clinicians in 75% of patient medical records. Additional occupational history data were charted much less frequently. A diagnosis of OA was made in only 2% of patients. Clinical action to address OA was documented for only one patient.

Conclusions: Clinicians who manage adults with newly diagnosed asthma take incomplete occupational histories. We detected discordance between the occupational exposure histories documented by patients and those charted by clinicians. OA may go unrecognized and possibly undermanaged by clinicians.

Key Words: asthma • occupational exposure • occupational medicine • workplace






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American College of Chest Physicians.