1. Promoting evidence-based practice in occupational asthma PEROSH 2015 Dr Chris Barber on behalf of the Centre for Workplace Health HSL Buxton UK

2. Occupational asthma 1 in 6 cases of adult onset asthma ~1500-3000 new cases UK per year Long-term ill health Prognosis improved with early diagnosis Adverse socio-economic outcomes UK costs of > £1 billion over last decade

3. The patient journey TIME

4. The evidence-base Patient journey

6. Anees, W et al. Thorax 2006 Exposure and lung function decline

7. Copyright ©2006 BMJ Publishing Group Ltd. Anees, W et al. Thorax 2006;61:751-755 Impact of removal from exposure

8. Evidence-based guidance

9. Aimed at a primary care audience – Improve knowledge – Increase awareness of guidelines – Assess the module Developed with academic GP Research Unit Messages taken from the evidence-based guidelines Co-funded by HSE and BOHRF Hosted and marketed by BMJ Learning Translation into e-learning

11. Occupational asthma module Introduction Pre-test of knowledge (10 questions) Interactive case history (12 scenarios) with learning points Video Summary Post-test (70% pass mark for CPD certificate) Links to further information Participants asked to leave qualitative feedback Users e-mailed to assess impact

12. Interactive case history 1.A 39 year old previously fit and well cleaner comes to see you with a history of shortness of breath and a persistent wheezy cough. She has never smoked, and has had no previous health problems. Spirometry is normal, but serial peak flow measurements confirm diurnal variability typical of asthma. What specific questions should you routinely ask all adults with new onset asthma? a.Whether they work and if so what they do b.When their symptoms started c.Whether their symptoms improve away from work d.All of the above

13. a.Whether they work and if so what they do b.When their symptoms started c.Whether their symptoms improve away from work d.All of the above Your answer [ ] [X] [ ]

14. a.Whether they work and if so what they do b.When their symptoms started c.Whether their symptoms improve away from work d.All of the above Your Correct answer [ ] [ ] [X] [ ] [ ] [ ] [ ] [X]

15. a: Whether they work and if so what they do Occupational factors are estimated to account for 9- 15% of cases of asthma in adults of working age, including new onset or recurrent disease. BOHRF b : When their symptoms started Sensitisation and occupational asthma are most likely to develop in the first years of exposure for most agents. SOC c : Whether their symptoms improve away from work An improvement in symptoms when away from work has been shown to be a good indicator that occupational asthma may exist. BOHRF d : All of the above All these statements are correct

16. Learning bite Health practitioners should enquire of any adult patient with new, recurrent, or deteriorating symptoms of asthma about their job, the materials with which they work, and whether their symptoms improve regularly when away from work. BOHRF A period of time between first exposure to a putative agent and the development of work related respiratory symptoms (the latent period) is recognised as a typical feature of occupational asthma. SOC

17. Personal impact

18. After 6 months: – Mean test scores improved from 70% to 92% – 98% positive feedback (n=682) – Feedback themes: increased awareness, change of practice Findings published in 2010 Module updated in 2013 Assessing the module

19. How frequently do you look after adults with any form of asthma?

20. How useful has this module been in raising your awareness of occupational asthma?

21. Since doing the module, how likely are you to use evidence based guidelines for patients with possible occupational asthma?

22. British Thoracic Society (BTS) award for Excellence in Delivery of Respiratory Education 2013 5713 users from 96 countries – 4145 doctors – 1427 nurses – 141 others (e.g. student, paramedic, pharmacist) Further occupational asthma module for trainee respiratory physicians launched with BTS in 2014 – >1800 visits National occupational lung disease course launched in 2014 in partnership with BTS.

23. Estimated annual changes in incidence of OA - physician reporting ©2015 by BMJ Publishing Group Ltd

24. Reported causes of OA (SWORD UK) % of cases

25. The future British Thoracic Society –Occupational lung disease e-module for BTS Learning Hub –National OLD short course 2016 HSE asthma research continues –Intervention study of asthma in foundry workers –Trends in isocyanate asthma and biological monitoring Stocks 2015 –Spray painter behaviour Clayton 2015

26. Any questions?