SCREENING QUESTIONNAIRES FOR BAKERS ASTHMA - ARE THEY WORTH THE EFFORT

The use of a respiratory screening questionnaire is recommended annual ly to screen bakery workers in the UK. We compared questionnaire scree ning with other methods of detecting workers with asthmatic symptoms a nd then assessed the significance of these symptoms with careful inves tigation and follow-up. Reasons for questionnaire failures were then e xplored. A questionnaire was issued to 362 flour-exposed workers in a large bakery. Ai I positive respondents to respiratory symptom questio ns were interviewed by an occupational nurse. Workers with occupationa lly related symptoms al this interview were referred to the chest clin ic. In addition, workers with negative questionnaires were screened us ing attendance records, sick notes and direct workplace observations. Workers with frequent absence from work or sick notes with respiratory diagnoses we re interviewed in the same manner as those answering the questionnaire positively and then referred to clinic. At clinic, a di agnosis was made for each worker on the basis of clinical assessment, spirometry, serial peak expiratory flow rate (PEFR) analysis and radio allergosorbent testing (RAST) testing for specific IgE. Using the clin ic diagnoses, the referral routes were audited to assess the rates of case detection of asthma and occupational asthma. The respiratory scre ening questionnaire identified 68 workers with respiratory symptoms. O f these, 21 proceeded to full assessment. A diagnosis oi asthma was ma de in five cases, one of which was bakers' asthma. In addition, 11 wor kers not reporting any symptoms by questionnaire were referred to clin ic and five were diagnosed as having asthma. Screening questionnaires may lead to an underestimate oi the prevalence oi asthmatic symptoms a nd as such should not be used alone in workplace screening.