Real-world use of Exposure Screening Questionnaires in Occupational & Interstitial Lung Disease clinics in Birmingham, UK

Occupational and interstitial lung diseases (OLD & ILD) such as hypersensitivity pneumonitis (HP) and occupational asthma (OA), may be precipitated by environmental or occupational exposures. Enquiring about such exposures can be time-consuming and incomplete. Identifying a causative exposure in OA or HP can be disease course changing, and validated exposure questionnaire use has been proposed (Barnes et al. 2020 Jun;157(6):1506-1512). We developed a quality improvement project to integrate exposure screening into our ILD & OLD clinic consultation process as patient assessment and multidisciplinary team (MDT) workup. It aimed to use and adapt existing validated exposure screening questionnaires for use in ILD/OLD clinics at the Birmingham Chest Clinic (BCC), UK. Retrospective data was collected regarding use and compliance with paper-based exposure questionnaires, and its incorporation into MDT patient outcomes. Between August and November 2023, 289 patients had appointments at BCC; 24 did not attend and 91 were 'new' patients; of these; 14 patients had an exposure questionnaire uploaded to the clinical record (September=6, October=3, November=5). All had exposure history taken and documented in clinic letters, but only 8 mentioned use of an exposure questionnaire. Of the 14 whose questionnaires were completed, 2 indicated they had no exposures. Number of exposures reported varied from 1-7. Ongoing data collection will show the effect of exposures collected reflected in MDT outcomes. There are significant administrative & logistical challenges to incorporating exposure screening into clinical assessment. Further QI work is ongoing to appraise and improve pathways.