Industrial injury benefit for occupational asthma in north east of England
BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6990.1299a (Published 20 May 1995) Cite this as: BMJ 1995;310:1299
- a Chest Unit and Regional Unit for Occupational Lung Disease, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
- Correspondence to: Dr Stenton.
- Accepted 11 October 1994
Occupational asthma is the commonest occupational lung disease in the United Kingdom, with an estimated 1000 cases identified annually.1 Industrial injury benefit has been available since 1981 for asthma caused by several defined agents, and since October 1991 benefit has been available whatever the cause, provided that the diagnosis of occupational asthma has been established to the satisfaction of an adjudicating officer of the benefits agency.2 We reviewed the data on all claimants presenting to the Newcastle office of the Benefits Agency Medical Service over a one year period after the October 1991 revision of the regulations. We paid particular attention to the interaction of this service with the other medical services in the region.
Patients, methods, and results
Overall, 205 subjects (180 men) claimed benefit for occupational asthma over the study years. Their median age was 54 years (age range 17-76), 88 subjects being over the age of 60. Only 25 had been advised to apply by a medical practitioner, the others having decided to apply themselves or on the suggestion of a workmate or union representative.
Most subjects had evidence of airflow obstruction, 121 having a forced expiratory volume in one second of less than 80% of predicted values and 100 a ratio of forced expiratory volume in one second to forced vital capacity of less than 70%; 182 used inhaled bronchodilators or corticosteroids. The agents suspected of causing occupational asthma are given in the table. Many claimants had worked in the traditional industries of the region, such as shipbuilding and mining, and attributed their disease to the effects of welding fumes or inorganic dusts. These are not generally recognised as causes of occupational asthma.
Distribution of claimants for compensation of occupational asthma by agent and outcome
Occupational asthma was diagnosed in 56 cases. In most (49) the medical history provided the only information on which the diagnosis could be based. Serial peak flow measurements at and away from work were available in three cases, and inhalation challenge tests had been performed in four. The median duration of exposure to the causative agent was 10 years. Only 16 subjects were under the care of a hospital physician, though a further 15 had been in the past. Twenty subjects continued to be exposed to the agent thought to be responsible for their asthma.
Subjects awarded benefit were younger (coefficient from logistic linear regression 0.08/year (95% confidence interval 0.11 to 0.04)) and were three times (1.8 to 4.1) more likely to have worked with agents recognised as inducing asthma.
Comment
A high proportion of the claimants were fairly elderly and had worked in the traditional industries of the north east of England. They were probably familiar with the benefits system, having made previous claims for other industrial diseases such as deafness and pneumoconiosis, and only a few had discussed their eligibility for benefit with a medical practitioner. Despite this, their claims were not frivolous. Most were using inhaled drugs or had evidence of airflow obstruction, though in most cases this was probably due to chronic obstructive airways disease rather than asthma.
Almost half the subjects thought to have occupational asthma had never undergone any form of specialist evaluation, and in few had objective evidence in support of the diagnosis been sought. Yet occupational asthma is not always easy to diagnose from the history3 and often leads to irreversible loss of lung function.4 It has important financial consequences for people affected, their industries, and the economy. The cost of compensating the workers in this study to retirement age will be about pounds sterling1.8m. The costs of drug treatment will be about pounds sterling0.2m and the cost of lost work potential could be pounds sterling5m-10m.
This study suggests that medical practitioners under-refer cases of possible occupational asthma for specialist evaluation and for compensation. There is a potential for closer liaison between the benefits agency and other medical services, and this could lead to improved management for those who are affected.
PSS is medical adviser to the Benefits Agency Medical Service in Gosforth. Our views are not necessarily those of the agency.