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Original Research: COPD |

Occupational History Quality in Patients With Newly Documented, Clinician-Diagnosed Chronic Bronchitis

Ware G. Kuschner, MD, FCCP; Shainy Hegde, MBBS; Madhuri Agrawal, BSc, MSc
Author and Funding Information

*From the Pulmonary Section, US Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.

Correspondence to: Ware Kuschner, MD, FCCP, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Pulmonary Section, Mail Stop 111 P, Palo Alto, CA 94304; e-mail: ware.kuschnermd@va.gov


The work was performed at the Veterans Affairs Palo Alto Health Care System. The views and opinions of the authors do not necessarily reflect those of the Veteran Affairs Palo Alto Health Care System or of the US Department of Veterans Affairs.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):378-383. doi:10.1378/chest.08-1559
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Background:  Approximately 15% of cases of COPD, including chronic bronchitis, is attributable to occupational exposures. An occupational history is essential to identify exposures responsible for work-related chronic bronchitis.

Methods:  We conducted a structured retrospective analysis of the medical records of veterans, 18 to 70 years of age, newly diagnosed with chronic bronchitis in order to achieve the following: (1) to assess the quality of documented occupational histories; and (2) to characterize the management of patients with a history of exposure to a potentially hazardous respiratory substance. We also analyzed occupational exposure data reported by patients on a structured questionnaire.

Results:  Sixty patients were included in the final analysis. A total of 6,150 notes were reviewed. Occupational status was documented in the records of 54 patients (90%). A description of occupational duties was recorded in 32 records (53%), and work exposure data in 26 records (43%). Clinicians concluded that occupational exposures potentially contributed to chronic bronchitis in three patients (5%). A recommendation for exposure avoidance was documented for six patients (10%). On the questionnaire, most patients reported a history of occupational exposure to respirable substances and symptoms of cough and/or shortness of breath.

Conclusions:  Details about job duties and occupational respiratory exposures were documented in the records of approximately half of patients with newly diagnosed chronic bronchitis. Patient self-reports of occupational exposures and respiratory symptoms were common. A determination that occupational exposures contributed to chronic bronchitis was rare. Few patients were counseled to take measures to avoid occupational exposures. Work-related chronic bronchitis may be incompletely assessed and undermanaged by clinicians.


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