Evaluating a novel questionnaire to improve screening of work-related asthma
Published online October 16, 2024
Work-related asthma (WRA) accounts for up to 25% of all asthma cases. Despite this, it is severely under-reported and under-recognized. On average, there is a four-year delay from symptom onset to diagnosis of WRA, with delays in diagnosis associated with significant morbidity and worse health outcomes. Therefore, early detection and reporting of WRA are imperative. Primary care providers are often the first practitioners seen by individuals with asthma or asthma symptoms. However, these practitioners may not be aware of WRA or the relationship between asthma symptoms and the workplace, and there are barriers to obtaining a diagnosis at this level, including lacking time to take an occupational history and lack of access to objective testing. A screening questionnaire for WRA might improve the detection of WRA in primary care, reduce the time to referral for testing and specialists, and decrease the overall delay in diagnosis.
A study by MacKinnon et al. (2024) in The Journal of Allergy and Clinical Immunology: In Practice sought to conduct a definitive evaluation of the Work-related Asthma Screening Questionnaire (Long-version)(WRASQ(L))TM. The WRASQ(L)TM is a screening questionnaire administered to individuals who have confirmed asthma but suspected WRA. It contains questions on occupational history, current employment status, workplace-symptom relationships at current and past workplaces, exposures at current or past workplaces, and exposure avoidance. A positive answer to at least one workplace-symptom relationship question was considered a positive screen for suspected WRA. It also includes an interpretation guide to prompt the provider on “next steps in care” based on a positive or negative screen for suspected WRA.
Employed adults with a physician-confirmed diagnosis of asthma who could take time off work during the study period were invited to participate from two hospitals in Canada. Participants filled out the WRASQ-LTM and then monitored their lung function at work and while away from work for approximately four weeks or completed specific inhalation challenge (SIC) testing. Two asthma specialists, blinded to WRASQ(L) answers, individually reviewed lung function data and SIC tests to classify participants as WRA or non-WRA.
Of the 106 enrolled participants, 22 (20.8%) were classified as having WRA. The WRASQ(L)TM has a high sensitivity (90.9%) and negative predictive value (93.1%), but poor positive predictive value (26.0%) and specificity (32.1%). In this specific context, we are primarily concerned with sensitivity; highly sensitive screening tests decrease the chance of missing patients with a disease. The WRASQ(L)TM’s high SN ensures that few patients will be missed, decreasing potential delays in diagnosis. In addition,, the interpretation guide further quickens the diagnostic process by outlining the next steps in care for those patients who screen positive for suspected WRA. Beyond its sensitivity, using the tool in clinic can prompt a discussion between the provider and patient on the relationship between the workplace and workplace exposures and asthma symptoms, increasing awareness of WRA and this relationship. Further, it is a quick way to collect occupational history and exposure history for providers. Therefore, there is merit in implementing this novel questionnaire in clinical practice after a final validation is conducted, as it fills many gaps identified in WRA diagnosis, screening, and management.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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