P6 Work-related respiratory symptoms in the UK; Do primary care physicians miss diagnostic opportunities in occupational asthma?

Introduction and objectivesOccupational lung disease is prevalent and costly. Population-based studies show that up to 20 cases of occupational lung disease per 100 000 workers per year should be identified.1 The Health and Safety Executive estimates the cost of occupational asthma to our society to be over £1.1 billion for each 10 year period.2 The prognosis of these individuals is better if they are removed from exposure quickly; however, this policy leads to unnecessary job loss in cases where the diagnosis is wrong.3 Little is known about the number of workers who present to primary care with work-related symptoms, or what proportion of these are referred for hospital specialist advice once a work-related element has been identified.MethodsThe Health & Occupation Reporting network in General Practice (THOR-GP) at the University of Manchester, collects work-related ill-health data from between 250 and 300 GPs trained to diploma level in occupational medicine. Cases of undiagnosed respiratory disease, reported as unspecified work-related respiratory symptoms between 2006 and 2009 were retrospectively identified. The cases were subdivided into exposure (if known) and categorised as referred if sent to a hospital specialist for further investigation.ResultsIn 2006–2009 GPs reported 4902 cases of work-related ill-health, of which 115 (2%) were reports of respiratory disease. 27 cases of non-specified work-related respiratory illness were identified. Only 26% (7/27) were referred for a specialist opinion despite uncertainty of diagnosis. Of those not referred, the majority (17/20) were exposed to known asthmagens as illustrated in Abstract P6 Figure 1 (consensus view after exposure review from three occupational/respiratory physicians).Abstract P6 Figure 1Agents attributed to cases reported with respiratory symptoms referred to hospital specialists.ConclusionsMore than three quarters of the cases with undiagnosed work-related symptoms identified in primary care were not referred to secondary care for diagnostic clarification. 85% of these cases were exposed to known asthmagens. The lack of diagnosis and/or specialist assessment in these cases may have significant impact on disease prognosis, disability and socio-economic cost to society.