PHYSICIAN BASED SURVEILLANCE SYSTEM FOR OCCUPATIONAL RESPIRATORY-DISEASES - THE EXPERIENCE OF PROPULSE, QUEBEC, CANADA

Objective-To evaluate the feasibility of implementing a physician base d surveillance system of occupational respiratory diseases (PROPULSE) in Quebec with regard to physician participation rate, characteristics of reported cases, and comparison with official statistics from the W orkers' Compensation Board (WCB). Methods-All chest physicians and all ergists in Quebec were asked to report suspected new cases of occupati onal respiratory diseases, on a monthly basis, between October 1992 an d September 1993. For each case, personal information was collected an d the physician's opinion on whether the condition was related to work was categorised as highly likely, likely, and unlikely. Results-Of th e 161 physicians initially approached, 68% participated. Physicians ra ted 48% of suspected cases as highly likely, 29% as likely, and 20% as unlikely. The most often reported diagnosis was asthma (63%), followe d by diseases related to asbestos (16%). Silicosis was less frequent ( 5%) but it was reported for six workers under 40 of whom five were inv olved in sandblasting activities. The high proportion of cases of asth ma probably reflects the increasing importance of this disease but may also reflect the different patterns of reporting among physicians wit h different expertise. The distribution of cases by diagnostic categor y is quite different between the PROPULSE system and that of the WCB ( annual mean number of compensated cases during a four year period). As thma and allergic alveolitis are more frequent in PROPULSE, reactive a irways dysfunction syndrome are about the same in both systems, and ot her diseases are more frequent among compensated cases. The most frequ ent sensitising agents reported for asthma were the same in both syste ms (isocyanates, flour, and wood dust). 15% of the PROPULSE cases were not covered by the WCB, and therefore would not be found in the board 's official statistics. Conclusions-A physician based reporting proced ure can be implemented as part of a surveillance system to supplement data from other sources and thus provide a better understanding of the occurrence of occupational respiratory diseases.