Reducing incidence of occupational asthma related to reduced reporting rather than reduced incidence

Several notifications schemes, including Shield in the West Midlands, UK, have noticed a reducing trend for reports of occupational asthma. An analysis of the Shield database has shown that this is likely to be mainly due to lack of diagnosis and reporting, rather than reduced incidence. The analysis has assumed that the true incidence of bakers asthma has not changed, as the dose/response relationships between flour, enzymes and sensitisation are well established and production methods have not changed sufficiently to have significant effects on incidence. Reports of bakers asthma have declined similarly to other causes. The lack of diagnosis may be due to lack of action following symptoms identified at workplace surveillance, and an unwillingness of workers to identify symptoms at at time of economic recession. GPs, at least in the UK, are being rewarded for reducing referrals to specialist centres where a diagnosis of occupational asthma is more likely to be made.

References

	Walters GI, Kirkham A, McGrath EE, Moore VC, Robertson AS, Burge PS, Twenty years of SHIELD: decreasing incidence of occupational asthma in the West Midlands, UK? , Occup Environ Med, 2015;72:304-310,10.1136/oemed-2014-102141

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