Assessment of the Use of a Work-Related Asthma Screening Questionnaire in a Primary Care Asthma Program

Abstract

Background: Work-related asthma (WRA) is under-recognized and early detection is associated with improved outcomes. The Work-related Asthma Screening Questionnaire (Long-version) (WRASQ(L)) is a 14-item tool designed to increase the detection of WRA in primary care. Purpose: The purpose of this study was to assess whether the WRASQ(L) provided additional and reliable information on a patient’s likelihood of WRA, beyond what is collected in standard care, to explore the relationship of WRASQ(L) responses to clinical actions and to assess the use of the WRASQ(L) in the primary care setting. Methods: This was an intervention study involving two Ontario Primary Care Asthma Program (PCAP) sites assigned the WRASQ(L). Standard care for asthma patients in PCAP sites involved completing the Asthma Care Map (ACM), a clinical pathway which included seven WRA screening items. Consent to participate in this study involved completing an electronic WRASQ(L) at each visit for participants and prompted care providers to record details related to WRA investigations. Results: The study sample (N=37) was predominantly female (73.0%), with a mean age of 46.3 years (SD, 10.9). Use of the WRASQ(L) identified work-related symptoms, exposures and high- risk past occupations in 38% and 60% and 47% of participants, respectively, that were not identified in standard care. Two participants were newly-suspected cases of WRA during this study period. WRASQ(L) items demonstrated fair to moderate reproducibility, but estimates may have been subject to measurement error. Incorporation of the electronic WRASQ(L) in clinical care was limited by time constraints and technical factors, such as ease of use and flexibility of the application. Conclusions: The WRASQ(L) provided added information about possible WRA over standard care. Use of the questionnaire’s results by care providers in this study was limited due to barriers encountered in incorporating the use of the WRASQ(L) in clinical practice. Future directions include the validation of this tool in relation to WRA diagnosis. The WRASQ(L) has the potential to increase recognition of WRA, improving long-term health outcomes for those with WRA.