If you want to cure their asthma, ask about their job.

Occupational asthma is the most common occupational respiratory disorder and accounts for 15% of cases of adult asthma. A recent systematic review of evidence and management has clarified patient care for General Practitioners (GPs) who are key professionals in early diagnosis. Exposure to respirable agents in the work environment by means of dust, water aerosol or gases, causes an allergic sensitisation process in the respiratory tract. Initial rhinitis and night cough may progress to patterns of work-related wheezing from two weeks to six months after starting employment. The absence of symptoms while on holiday or sick leave suggests the diagnosis. Serial peak flow recordings show characteristic patterns. Smoking and atopy have a variable influence on whether a worker will develop the disease with exposure. Early identification and removal from exposure is essential for the worker since it improves prognosis. Other workers will be at risk, and occupational hygienists are required to measure and improve the working environment by means of ventilation and extraction of toxic fumes. Workplaces with workers who are at risk of occupational asthma, such as paint sprayers, food processors, welders and animal handlers, require health surveillance programmes for new and existing employees, as well as reinforcement of the more important primary safety measures of environmental monitoring and respiratory protection. All clinicians responsible for asthma management need to be aware of the potential for occupational asthma in new cases of adult asthma or unexplained worsening of pre-existing asthma. Specialist help is required to confirm the diagnosis, which has substantial legal and economic implications for the worker and their employer.

Virological surveillance of influenza-like illness in the community using PCR and serology.

BACKGROUND: Surveillance of winter respiratory viral illness has been carried out for nearly 30 years using a clinical diagnosis by general practitioners as part of the Scottish Sentinel General Practice (SSGP) network. Contemparaneous laboratory diagnosis has not been available previously. OBJECTIVES: To assess the proportion of influenza-like illness (ILI) attributable to influenza, respiratory syncytial virus (RSV) and picornavirus infection during the winter season. To compare the influenza PCR data with serology of paired blood samples. STUDY DESIGN: Combined nose and throat swabs, from patients with ILI attending 15 general practices across Scotland, were submitted to the laboratory in virus PCR sample solution (VPSS). The extracted nucleic acid was tested using a multiplex reverse-transcription polymerase chain reaction (RT-PCR) assay. Serological analysis was performed on paired serum samples using complement fixation assays. The rate of influenza virus positivity was compared with reports of ILI obtained from the SSGP network. RESULTS: Of 240 samples received at the laboratory, 132 (55%) were PCR positive for influenza A virus. There were nine (3.8%) picornavirus and three (1.2%) RSV PCR positives, two (0.8%) were dual influenza A/picornavirus infections. Ninety four (39.2%) were negative for all viruses tested. Results on paired sera from 89 patients showed a rising titre to influenza A in 48 of the 57 PCR positive samples (84.2%). One PCR negative patient displayed a significant rising titre to influenza A. Virological data paralleled the SSGP data but was available at least a week earlier. CONCLUSIONS: Influenza A infection was detected in the majority of patients with ILI; picornavirus infection was also shown to be an important cause of illness. PCR is a rapid and sensitive method for respiratory virus surveillance. Serology is slow, insensitive and difficult to interpret at low titres.