What are the current guidelines for monitoring and managing patients with occupational asthma in primary care?

Monitoring and managing patients with occupational asthma in primary care involves the following key steps:

• Identification: In adults with new-onset asthma, poorly controlled asthma, or recurrence of childhood asthma, primary care clinicians should actively check for a possible occupational component by asking if symptoms improve on days away from work, during holidays, or on weekends. All responses should be documented for review NICE NG245.
• Referral: Patients with suspected occupational asthma should be referred promptly to an occupational asthma specialist for further assessment and management NICE NG245.
• Asthma control monitoring: At every review, assess asthma control by asking about symptoms, time off work due to asthma, reliever inhaler use (including prescription checks), courses of oral corticosteroids, and any hospital admissions or emergency visits related to asthma NICE NG245.
• Use of validated tools: Consider using validated symptom questionnaires such as the Asthma Control Questionnaire or Asthma Control Test during reviews to objectively assess control NICE NG245.
• Objective testing: Regular peak expiratory flow monitoring is not routinely recommended unless part of a personalised asthma action plan. Fractional exhaled nitric oxide (FeNO) monitoring may be considered in adults at regular reviews and before/after therapy changes NICE NG245.
• Personalised action plans and education: Provide patients with personalised asthma action plans and education, including advice on minimising exposure to occupational triggers and other environmental factors NICE NG245.
• Annual review and after exacerbations: Conduct at least annual reviews and after any exacerbation by trained healthcare professionals, incorporating personalised action plans and considering telehealthcare or computerised decision support to support self-management NICE NG245.