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Occupational Asthma and Work-Exacerbated Asthma^*

Factors Associated With Time to Diagnostic Steps

^* From the Gage Occupational and Environmental Health Unit (Drs. Santos, Liss, and Tarlo), Toronto, ON, Canada; University of Toronto (Ms. Jung and Dr. Lou), Toronto, ON, Canada; and Toronto Western Hospital (Dr. Peyrovi), Toronto, ON, Canada.

Correspondence to: Susan M. Tarlo, MBBS, FCCP, Gage Occupational and Environmental Health Unit, University of Toronto, 223 College St, Toronto, ON, Canada M5T 1R4; e-mail susan.tarlo{at}utoronto.ca

Abstract

Background: Little is known regarding the factors associated with the times for patients’ first physician visit, the first physician suspicion of work-related asthma (WRA), and final diagnosis after the onset of WRA symptoms. This study examined individual and work-related factors that are associated with longer times to these diagnostic milestones among groups with occupational asthma (OA) and work-exacerbated asthma (WEA).

Method: Suspected WRA cases were identified from an occupational lung disease clinic and claimants to the Ontario Workplace Safety and Insurance Board (100 patients each). Questionnaire administration and chart review were undertaken.

Results: Eighty participants were classified as having sensitizer-induced OA and 87 as having WEA. For the OA group, the risk factors for delay included male sex, being unmarried, low education, and lack of awareness of association of symptoms with work. Other factors included older age, being the sole income earner, and lack of knowledge of the Workplace Hazardous Materials Information System program. For WEA, lower household income, lower education, absence of a health-and-safety program at work, absence of a union, and lack of awareness of OA and of agents at work that could affect asthma significantly increased the time to diagnostic milestones.

Conclusions: Different factors affect the diagnostic milestones for OA and WEA. Findings suggest a need for educational programs for workers who are at risk of OA and WEA and a need for further primary care physician education on WRA.

Key Words: asthma • diagnosis • occupational asthma • socioeconomic factors • work-exacerbated asthma • workplace • work-related asthma