A Guide for the Primary Care Physician in Evaluating Disocyanate-Exposed Workers

CME/MOC: 1.0
TRACK: OEM Clinical Practice

David I. Bernstein, MD, University of Cincinnati College of Medicine, Cincinnati, OH
Athena T. Jolly, MD, MPH, FACOEM, UPMC Susquehanna, Williamsport, PA
Mark W . Spence, MD, International Isocyanate Institute, Inc., Midland, MI

Occupational health care providers are often asked to evaluate workers exposed to diisocyanates who are presenting with lower respiratory symptoms at work for respiratory sensitization to diisocyanates. In this scenario, providers need to consider a differential diagnosis that includes non-asthmatic etiologies, aggravation of a pre-existing asthmatic condition, and irritant induced asthma, and which objectively confirms the correct diagnosis using accessible clinical tools. This guide has been developed with the objective of assisting primary care providers, not experienced in the evaluation of occupational lung, to perform an initial evaluation of workers with suspected diisocyanaterelated occupational asthma. The guide describes a variety of work-related asthma conditions that must be considered and provides a step-wise approach to the evaluation of work-related asthma. Limitations of this approach will be identified and the importance of an expert assessment by an industrial hygienist presented.