Occupational symptom-based diagnosis

The diagnosis of COPD is based in part on the patient s symptoms and a history of exposure to risk factors such as tobacco smoke and occupational exposures. 

Shortness of breath, cough, and wheeze are common symptoms of respiratory diseases (Table 3.2). These shared symptoms make misdiagnosis by physicians common if the diagnosis is based solely on reported symptoms. Medical tests help to distinguish the respiratory diseases from each other (Table 3.3). Other pitfalls in medical diagnosis include diagnosing common diseases (such as asthma, emphysema, and chronic bronchitis) instead of the actual rarer diseases (such as BO) and not considering occupational exposures as the cause. 

The diagnosis of COPD is made based on the patient s symptoms, including cough, sputum production, and dyspnea, and a history of exposure to risk factors such as tobacco smoke and occupational exposures. Patients may have these symptoms for several years before dyspnea develops and often wiU not seek medical attention until dyspnea is significant. The common features noted at presentation are summarized in Table 27-4. 

The diagnosis of allergic alveolitis is based on a series of nonspecific clinical symptoms. As in medicine in general, the history is the most important diagnostic aid. It is very important to ask about exposure to offending antigens in patients with symptoms compatible with allergic alveolitis. To ask about a patient s occupation is one of the basic questions a doctor should ask his patient, as pointed out centuries ago in 1700 by Ramazzini. It is also very important to carefully analyze the symptoms. When did they appear in relation to the exposure Several other important key facts (Fink et al. 2005) should always be included in the history, such as ... 

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