Screening tools for work-related asthma and their diagnostic accuracy: a systematic review

Area of Science:

• Occupational Medicine
• Respiratory Medicine
• Diagnostic Accuracy Studies

Background:

• Work-related asthma (WRA) accounts for a significant portion of adult asthma cases.
• Delayed or missed clinical diagnosis of WRA leads to adverse health and employment outcomes.
• The diagnostic performance of existing WRA screening tools requires standardization and evaluation.

Purpose of the Study:

• To systematically review and compare the effectiveness of screening tools for identifying work-related asthma (WRA).
• To evaluate WRA screening tool performance in both clinical and occupational settings.

Main Methods:

• A comprehensive literature search was conducted across multiple databases for studies published between 1975 and 2024.
• Included studies utilized structured questionnaires or predictive models (with or without physiological tests) for WRA identification in individuals aged 16 years and above.
• Risk of bias was assessed using QUADAS-2 or PROBAST, and accuracy indices were summarized using forest plots.

Main Results:

• Seven studies were included, primarily conducted in tertiary and specialist hospital settings.
• Questionnaires alone ('improvement off work' or multiple questions) demonstrated high sensitivity (74-100%) but low specificity (8-58%) for WRA detection.
• Adding a methacholine challenge test improved specificity to 75% (sensitivity 65%), and diagnostic models achieved an AUC between 0.69-0.89, enhanced by demographic or objective data.

Conclusions:

• Screening questionnaires for WRA offer high sensitivity, suitable for initial case identification, despite low specificity.
• Incorporating demographic variables and objective tests can enhance the specificity and predictive accuracy of WRA screening models.
• Limited reporting and study numbers necessitate further WRA screening tool evaluations in primary care and workplace environments.