Video: Dr Mark Piney interviews Dr David Fishwick about occupational asthma

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Dr Mark Piney Could you just give me some idea of your of your job and your experience please.

Dr David Fishwick Yeah certainly Mark. I am a Consultant Respiratory Physician at the Royal Hallamshire Hospital in Sheffield sort of industrial heartland of the UK. And I also work as the Chief Medical Officer at the Health and Safety Laboratory. Also a reader in medicine in the University of Sheffield so I've got a rather odd complicated job.

Dr Mark Piney Right.

Dr David Fishwick Erm I experienced …some training in medicine in Manchester in the erm early 80's I qualified in 85. And since that time I've always had a major enthusiasm for chest problems or respiratory disease.

Dr Mark Piney So in your experience do you find that people get missed as it were. They've been to their GP they he or she has said well yes you seem to have got asthma, and they give them treatment, but they never it takes some time to get the connection.

Dr David Fishwick We've relatively recently finished a study in the United Kingdom looking at this very point. In other words if you are a worker working as a spray painter and you get symptoms of wheeze or shortness of breathe you go and see your family doctor, how long does it take a person like that to get to an appropriate hospital specialist. And we looked at about 100 cases of people nationally with possible occupational asthma, and the average was about 2 or 3 years. But there was some stars out at 28 years so there are major delays for certain individuals in the system. And of course if those people are continuing to exposure themselves in the work environment that could be doing much more harm.

Dr Mark Piney Right. And what happens to patients with occupational asthma. Erm in your experience I mean you you see them sometimes quite later in the day I guess and others are picked up earlier in the day when their systems are relatively mild. Could you give this some idea of what happens to them.

Dr David Fishwick Well to give you an example I saw a case a few months ago of a worker working in a food processing plant who had become so unwell on nightshift that he had to be dragged out of the workplace by by his colleagues desperately ill with asthma. Never previously been diagnosed. Almost died and had to be taken to hospital. So only about a few months later that the penny dropped that this gent had been working with prawns. And prawn meat itself can cause an allergy and asthma. Now I'm not saying that most people with occupational asthma almost die but asthma is a serious condition. If people continue to exposure themselves like this gent I've just talked about it could have caused him fatal or exceeding severe asthma if it was not picked up.

Dr Mark Piney OK.

Dr David Fishwick Thankfully for most people the situation is a bit clearer. If you continue to exposure yourself you are likely to have troublesome continuing asthma symptoms. If you stop exposure in other words you're a spray painter, the diagnosis is made and you retrain and don't expose yourself to paints. About a third of those individuals even though they are not now exposing themselves will get worse. About a third will stay the same and about a third will improve. So the bottom line is it's a serious problem and reducing or stopping exposure doesn't always cure people.

Dr Mark Piney Occupational health surveillance. People erm expose to ……..should be under occupational health surveillance. What's your views on what's good occupational health surveillance can you give me an example of where it's worked.

Dr David Fishwick Occupational health surveillance is very important for watching groups of workers who may be exposed to agents that cause asthma. For those for those who are unaware about what occupational health surveillance is it maybe a nurse or a doctor seeing each individual within a workforce. For example a spray painting garage every year. To ask them a very brief set of questions about their breathing and perhaps also take some measurements for their breathing test.

Dr Mark Piney Hmm.

Dr David Fishwick I think good practice for individuals who are exposed to …….in the workplace is to be seen at least yearly and this could be by a responsible person such as a nurse or a physician. Normally in the workplace this will be a nurse or an occupational health provider. At that meeting the worker would be allowed to talk about breathing problems and hopefully in most cases that's going to be very quick because there won't be any. But as you make the point in the question if there are early beginnings of asthma it is best to pick it up in that environment rather than wait erm for acute asthma or bad asthma to occur. I would also think breathing tests are important every year as well for individuals who are exposed to known ……..

Dr Mark Piney You get compensation based on disablement and how that disablement is judged. So for instance at the moment it's about £70 a week if your 50% disabled. What does 50% disabled mean if you're an asthmatic.

Dr David Fishwick Well asthma is a very variable condition so we have to take that into account when we are calculating disability. For example asthma may be very troublesome to a worker on one day but on another day they may just be absolutely fine. So patients can be very disabled on one day and not disabled at all on another. So my comments relate to a sort of average over a period of time.

Dr Mark Piney Right.

Dr David Fishwick 50% disablement would generally imply quite significant shortness of breathe. To give you an example, climbing a flight of stairs would be difficult. Walking around a supermarket even without pushing a trolley would be difficult. And you wouldn't be able to keep up with people of your own age on level ground when walking. You might even have to stop even at your own pace on level ground when walking at that level of disability, so it's quite marked.

Dr Mark Piney It's quite marked and your quite disabled by it then.

Dr David Fishwick Absolutely and of course that's what I am sure why the DSS has drawn a line at that point in terms of erm disability or in terms of what your describing in terms of money income because of the fact that it is really quite marked impact. It has a marked impact on your life. INT OK.