Use of objective testing in the diagnosis of work-related asthma by physician specialty.

BACKGROUND: Although early and accurate diagnosis of work-related asthma is critical to avoid unnecessary medical, legal, social, and economic consequences, little is currently known about the diagnostic practices of physicians treating workers with work-related asthma. OBJECTIVE: To characterize the use of objective diagnostic testing for work-related asthma by physician specialty. METHODS: A cross-sectional, descriptive, comparative evaluation was conducted of 301 workers' compensation claimants with work-related asthma. RESULTS: A few claimants (36.9%) were treated by specialists in work-related asthma (allergists, pulmonologists, or occupational medicine physicians) either initially or through the course of their claim. Workers with occupational asthma were more likely to have seen a specialist than those with work-aggravated asthma (47.9% vs 23.0%; P < .001). Less than half of the claimants with work-related asthma (43.2%) had received an objective evaluation of pulmonary function, through either pulmonary function testing or testing for reversible airflow limitation, for the evaluation of their work-related asthma. Claimants treated by specialists were significantly more likely to have received diagnostic testing during evaluation of their disease than those treated solely by generalists (82.9% vs 20.0%; P < .001). CONCLUSIONS: The results of this study point to the lack of appropriate diagnostic care received by workers with work-related asthma. Physicians who may have questions about diagnostic procedures should consider referral to a specialist. The development of referral networks for work-related asthma may be warranted and should be explored.

Work-related asthma in the spray-on truck bed lining industry.

OBJECTIVE: The objective of this study was to identify work-related asthma (WRA) workers' compensation claims associated with methylene diphenyl diisocyanate (MDI) exposure in the spray-on truck bed lining industry and estimate the asthma incidence rate in this industry. METHODS: The authors conducted a descriptive study of workers' compensation claims meeting an established surveillance case definition for WRA. RESULTS: Eight WRA workers' compensation claims were identified in the truck bed lining industry in Washington State for a claims incidence rate of 200 per 10,000 full-time equivalent. The medical evaluation of the cases was inadequate because none of the truck bed lining cases had medical testing to objectively link their asthma to the workplace. CONCLUSIONS: The rate of work-related asthma in the truck bed lining industry is excessive and suggests a need for significant intervention, including improvements in the clinical assessment provided to MDI-exposed workers.

Reaching managers at an industry association conference: evaluation of ergonomics training.

Managers rarely receive targeted safety and health training, despite the belief that management support is important for a successful workplace safety and health program. A program evaluation was performed on an ergonomics workshop for managers attending an industry association conference. The goals were to determine whether the conference was an effective setting for the training, to assess whether the training led to an increase in participants' knowledge and ability, and to determine whether participants could use what was taught in an applied exercise. The majority of participants (97%) believed the conference was an effective setting for the training. Participants' knowledge and ability to identify musculoskeletal risks increased significantly following the training. Additionally, participants were able to identify musculoskeletal risk factors and suggest solutions during the applied exercise. Occupational health nurses should consider trade association meetings as a venue for educational training sessions and for disseminating their research results.