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Receptionist advises patient on phone to self-prescribe

By Daniel Cressey

GPs should consider occupational asthma in all workers with airway obstruction, new national asthma guidelines recommend.

The revised British Thoracic Society/SIGN guidance urges GPs to focus on diagnosis and referral of occupational asthma as part of a drive to cut preventable asthma deaths.

The guidance also provides a new template for patient self-management plans, which one BTS member warned were 'grossly underused'.

Professor Martyn Partridge, professor of respiratory medicine at Imperial College London and member of the guideline executive and steering committee, said: 'We have now recognised the need to really stress the correct diagnosis of work-related asthma. The reason for that is it is the only form of asthma we are able to cure.'

Dr Bernard Higgins, BTS member and consultant physician at the Freeman Hospital, Newcastle, said: 'Work-related asthma is the UK's fastest growing occupational disease ­ the guidance prompts all healthcare professionals to be aware it.'

The guidelines advise GPs to ask all adults with airway obstruction if their symptoms improve on days away from work, and to refer all those who answer Yes to an occupational or respiratory physician.

GPs should suspect an occupational cause in all adults with new-onset asthma or a recurrence of childhood symptoms, and 'positively search' for possible exposures.

Dr Dermot Ryan, a GP in Loughborough, Leicestershire, and a member of the BTS, said occupational asthma was an underestimated problem: 'I'm sure it's bigger than we think. The big problem is we've got a shortage of respiratory physicians but a much larger shortage of those who have an interest in occupational asthma.'

The guidelines list a number of high-risk professions and exposures (see box), although Professor Partridge stressed there were many more potential sensitisers.

He also stressed the need for use of self-management plans to improve. 'Self-management has been recommended for 15 years. We recognise it has not been well implemented.'

Dr Ryan added: 'I have no doubt that self-management plans are grossly underused.'

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