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《2008BTS職業(yè)性哮喘護理標準》內容預覽

Identification of occupational asthma in an individual can also serve as a ‘‘sentinel event’’, offering the opportunity to alert workplaces and public health agencies that there may be an increased risk to co-workers in the same workplace and to other workers with similar expo- sures which can result in intervention measures to reduce or eliminate this risk. Unfortunately, there has often been a period of several years between the onset of symptoms from occupational asthma and diagnosis.

Potential reasons for delay in diagnosis include workers’ lack of awareness of work-related asthma and of the association between their symp- toms and workplace exposures. This is especially likely when the sensitiser is a low molecular weight (chemical) sensiti- ser which may cause isolated late asth- matic responses occurring several hours after exposure. Symptoms may then be worst after leaving a work shift or during sleep after work. Even if they do recognise a work association, workers may be afraid to report this to their physician for fear of losing their job or transfer to a lower paid job (especially if working in a small company and/or without support from a union). Also, when seen by a healthcare worker, they may not be asked about the job and work-relatedness of symptoms. In a North American study of barriers to diagnosis of occupational asthma,the median time to suspicion by the physician of the diagnosis was 2 years and to final diagnosis was 4 years. Most patients reported that they only saw a physician when symptoms worsened or became unbearable, and only a minority had been aware of an agent at work potentially causing asthma. Only 57% of primary care physicians surveyed in Ontario, Canada reported always or usually taking a history of workplace exposures, citing time constraints as the most frequent reason for not doing this.In this and an earlier survey of members of the American College of Chest Physicians,a high proportion of physicians recognised the need for further education in occupational lung diseases

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