Abstract
Background
Occupational asthma (OA) refers to asthma caused by workplace-specific substances. A longer duration of symptoms while continuing to be exposed has been associated with a worse prognosis. Evidence suggests a significant period of time exists between symptom onset and diagnosis of OA, the reasons for which have not been investigated. The purpose of this study was to examine whether primary health care and/or socio-economic factors account for delays in Ontario.
Method
Two hundred and forty-seven (247) chart reviews were undertaken of patients referred to the University Health Network Asthma Centre for evaluation of OA, with clinic visits from 1997–2002. Forty-two (42) patients fulfilling objective OA criteria were administered a structured telephone interview to examine the chronology and nature of health care consultation and reasons for possible delay in diagnosis.
Results
The mean time to diagnosis was 4.9 years (3.4 years excluding 4 outliers). On average, patients waited 7.4 months before discussing the work-relation of symptoms with a physician. Main self-reported reasons for delay were lack of enquiry about work relatedness by the primary care physician (41%) and fear of losing work time (37%). Reported increases in time during secondary care were related to difficulties associated with completion of investigations (35%). Lower education level (p=0.04) and household income (p=0.03) were significantly associated with an increased time to diagnosis.
Interpretation
Physicians who assess working adults with asthma need to ask pertinent work-related questions when taking a history in order to initiate timely investigations and referral. Socio-economic factors are also associated barriers to early diagnosis of occupational asthma.
MeSH terms: Asthma, occupational diseases, early diagnosis, health services accessibility, socioeconomic factors
Résmé
Contexte
L’asthme professionnel (AP) est l’asthme causé par l’inhalation de substances présentes dans le milieu de travail. Le pronostic est pire lorsque les symptômes se prolongent en raison d’une exposition continue. Des données permettent de croire qu’il existe une période de temps appréciable entre l’apparition des symptômes et l’établissement d’un diagnostic d’AP, pour des raisons qui n’ont pas encore été étudiées. Nous avons voulu examiner si des facteurs liés aux soins de santé primaires et/ou des facteurs socio-économiques pouvaient causer de tels retards en Ontario.
Méthode
Nous avons examiné les fiches de 247 patients aiguillés vers la clinique de l’asthme du Réseau médical universitaire (University Health Network Asthma Centre) entre 1997 et 2002 pour une évaluation d’AP. Nous avons mené des entretiens téléphoniques semi-structurés avec 42 patients respectant des critères objectifs de diagnostic de l’AP afin d’examiner le moment et la nature de leurs consultations médicales et les raisons d’éventuels retards dans leur diagnostic.
Résultats
Le délai moyen de diagnostic était de 4,9 ans (3,4 ans après exclusion de quatre valeurs aberrantes). En moyenne, les patients avaient attendu 7,4 mois avant de discuter avec un médecin des liens possibles entre leurs symptômes et leur milieu de travail. Les principales raisons déclarées par les intéressés pour avoir attendu étaient que leur médecin de premier recours ne les avait pas interrogés sur leur milieu de travail (41 %) et la crainte de devoir s’absenter du travail (37 %). L’allongement des délais dans les soins secondaires était lié aux difficultés de l’enquête médicale (35 %). La faiblesse relative du niveau de scolarité (p=0,04) et du revenu du ménage (p=0,03) présentait une corrélation significative avec un délai plus long avant le diagnostic.
Interprétation
Pour que l’enquête et l’aiguillage se fassent en temps opportun, les médecins qui évaluent les travailleurs adultes asthmatiques doivent poser des questions pertinentes sur le milieu de travail lorsqu’ils les interrogent sur leurs antécédents. Des facteurs socio-économiques font également obstacle au diagnostic précoce de l’asthme professionnel.
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