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Dust could be a trigger and what appears to be a minor amount to us could easily trigger his symptoms and he would still have normal spirometry if tested outside work away from trigger etc.
I would suggest a full history about triggers, how and when he uses his inhalers in and out of work and ask him to keep a peak flow diary for 2 weeks....they need to take measure every 2 hours and note exposures, inhalers use etc. You can then see if there is any evidence correlating with work. You can download charts and instructions from asthma uk and I'm sure gp would be happy to lend a meter to him.
If it is a trigger it is unlikely to be an atopy trigger so unlikely to cause harm. One bloke I had we started the cleaners on damp dusting rather than dry and increased frequency to daily. We also checked all ventilation shafts for proper maintenance etc. That was enough to help him reduce impact of dust. In atopy work related allergies e.g working with animals we would refer to the Brompton.
Regards,
Carr
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Dear colleagues
Seeing a client next week who states he has asthma since birth, has never been hospitalised, not sure if any medication is being used.
He is bringing fit notes to the workplace reporting the reason for absence exacerbation of asthma. (he works outdoors in an area where there is some dust but not excessive)
He has had two consecutive normal spirometry tests.
I am a wee bit unsure of how to deal with this query. Would appreciate any comments on how you may process such a referral.
Many thanks in anticipation of any responses.
Regards
Marj Dawson
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