Approximately 13% of the Canadian adult population has been reported to have asthma, and, based on the answers to a questionnaire, 36% of those with adult-onset asthma had possible or probable “occupational asthma”. Asthma caused by exposure to an agent specific to a workplace and not to stimuli outside the work environment, is termed occupational asthma (OA), more strictly distinguishing it from coincidental/concurrent asthma that is aggravated or exacerbated at work, referred to as work-exacerbated asthma (WEA) or work-aggravated asthma. Work-related asthma (WRA) is a term including both OA and WEA. WEA is relatively common, accounting for approximately 50% of accepted WRA compensation claims in Ontario. WEA claims are associated with a relatively short period of time missed from work, and, unlike patients with OA, patients with WEA can often return to their usual workplace with adjustments to reduce exposures to likely airway irritants and/or with optimized asthma medication.
A minority of OA cases is due to a large exposure to a respiratory irritant. The clearest example of this was the initial description of reactive airways dysfunction syndrome, but broader criteria for irritant-induced asthma have also been used. More commonly (> 90% in a compensation claim population), OA is caused by sensitization to a specific work chemical or allergen. The outcome of sensitizer-induced OA improves with early diagnosis and removal from further exposure to the suspected sensi-tizers. Delayed diagnosis, more severe asthma at diagnosis, and prolonged exposure to the workplace agent after the onset of symptoms are associated with persisting asthma and morbidity, including hospitalizations.
In Ontario, the average time to the medical diagnosis of OA among workers with compensated Workplace Safety and Insurance Board (WSIB) claims was 2 to 3 years after the onset of symptoms. A pilot study has suggested a link between the average time to medical diagnosis and delays associated with worker/patient-related factors, workplace factors, physician/health-care factors, and compensation factors. To our knowledge, no other studies to date have addressed this in patients with WRA. Therefore, we aimed to identify individual and workplace factors relating to the longer time to diagnosis of OA and WEA.
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