What guidelines exist for the referral of patients with occupational asthma to specialist services?

Referral Guidelines for Patients with Suspected Occupational Asthma:

• Refer adults with suspected occupational asthma promptly to an occupational lung disease service or asthma specialist, ideally to be seen within 6 weeks of referral.
• Early specialist assessment is important because occupational asthma diagnosis has significant health, legal, economic, and employment implications and should not be based on history alone.
• If occupational asthma is confirmed, advise that the best opportunity for improved asthma control comes from early and complete removal of exposure to the causative occupational allergen.
• Patients who remain exposed to the occupational cause should remain under specialist follow-up to monitor asthma control, lung function, and the impact of workplace interventions.
• Referral is also indicated if there is diagnostic uncertainty or if symptoms persist despite optimized inhaled corticosteroid (ICS)-containing treatment for 3–6 months.

These recommendations are based on the collaborative BTS/NICE/SIGN guideline, the BTS clinical statement on occupational asthma, and the GINA guideline, which emphasize early referral and specialist involvement for suspected occupational asthma to ensure accurate diagnosis and management.

Summary: Refer adults with suspected occupational asthma urgently (within 6 weeks) to specialist occupational lung disease services; confirm diagnosis with specialist assessment; advise early removal from exposure; maintain specialist follow-up if exposure continues; consider referral if symptoms persist despite optimized treatment or if diagnosis is uncertain.

NICE CKS,NICE NG245