Physicians in Canada more reluctant to attribute asthma to work than carpal tunnel syndrome

A study in Alberta gave scenarios to physicians asking them whether they thought the patient described had an occupational disease or not. One scenario described a baker with new onset asthma and rhinitis, better on days off work. The asthma was confirmed with a large bronchodilator response and the presence of abnormal methacholine reactivity. 65% of respondents thought that the asthma was work-related. A similar scenario related to carpal tunnel syndrome was thought to be work-related by 96% respondents.

The reluctance of non-specialists to attribute asthma to work, even when the evidence is very strong, contributes to the long delays between presentation and diagnosis. This provides further evidence for the need for screening by generalists and early referral of screening failures. The best screening questions are to ask about rest-day and holiday improvement, something which guidelines recommend are added to every assessment of patients with airflow obstruction

References

	Beach J, Chen Y, Cherry N, How physicians allocate causation: a scenario study with factorial design, Occup Med (London), 2012;62:407-412,

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