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Canadian Respiratory Journal
Volume 22 (2015), Issue 6, Pages 341-347
Original Article

Investigation of Occupational Asthma: Do Clinicians Fail to Identify rRelevant Occupational Exposures?

Carlo de Olim,1 Denis Bégin,2 Louis-Philippe Boulet,3 André Cartier,1 Michel Gérin,2 and Catherine Lemière1

1Hôpital du Sacré-Coeur de Montréal;, Canada
2Department of Environmental and Occupational Health, ESPUM, Université de Montréal, Montréal, Canada
3Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies.

OBJECTIVE: The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare work-place exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC.

METHODS: SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC.

RESULTS: The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician.

CONCLUSION: The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA.