Evaluation and Application of the Work-Related Asthma Screening Questionnaire-Long Version (WRASQ(L))

Madison A MacKinnon; Taylar Wall; Alison Morra; Teresa To; Catherine Lemiere; M Diane Lougheed

doi:10.1016/j.jaip.2024.10.012

Evaluation and Application of the Work-Related Asthma Screening Questionnaire-Long Version (WRASQ(L))

J Allergy Clin Immunol Pract. 2024 Oct 16:S2213-2198(24)01066-3. doi: 10.1016/j.jaip.2024.10.012. Online ahead of print.

Authors

Madison A MacKinnon¹, Taylar Wall², Alison Morra², Teresa To³, Catherine Lemiere⁴, M Diane Lougheed⁵

Affiliations

¹ Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada; Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada. Electronic address: Madison.mackinnon@mail.utoronto.ca.
² Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada; Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada.
³ The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Chronic Disease and Pharmacotherapy Research Program, ICES, Toronto, ON, Canada.
⁴ Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
⁵ Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada; Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada; Chronic Disease and Pharmacotherapy Research Program, ICES, Toronto, ON, Canada.

PMID: 39424188
DOI: 10.1016/j.jaip.2024.10.012

Abstract

Background: The Work-related Asthma (WRA) Screening Questionnaire-Long Version (WRASQ(L)) is a screening questionnaire that could improve the recognition of WRA.

Objective: To conduct a definitive evaluation of the WRASQ(L) to justify its implementation in clinical settings.

Methods: Employed adults aged 18 to 75 years with asthma confirmed by objective measures and the ability to take time off work were eligible. Participants completed the WRASQ(L) and then monitored their peak expiratory flow at and away from work or completed a specific inhalation challenge test. Data were classified as WRA or non-WRA by 2 asthma specialists, blinded to WRASQ(L) answers. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV and NPV, respectively), and Youden's index were calculated for cutoffs of a positive screen.

Results: Of 106 participants (47.1 ± 7.1 years [mean ± standard deviation]; 60 [57%] female), 14 (17%) were classified as having WRA and were significantly younger in age than non-WRA participants (P = .043). The questionnaire has high SN and NPV (90.9% and 93.1%, respectively) but low PPV and SP (32.1% and 26.0%, respectively).

Conclusions: The WRASQ(L) has high SN and NPV. High SN is of primary interest to ensure that few false-negative screens are missed and those with potential WRA are identified and continue to specialist care. The SN indicates utility of the questionnaire in clinical settings. Further benefits of the tool include its potential to prompt education on the symptom-workplace relationship, workplace exposures, personal protective equipment use, and collect exposure and occupational history.

Keywords: Asthma; Occupation; Occupational asthma; Primary care; Screening; Work; Work-aggravated; Work-related.