# Bridging Gaps in Occupational Respiratory Disease Management: A Comparative Survey of Pulmonologists and Occupational Physicians in Italy

## TL;DR

This study compares how pulmonologists and occupational physicians in Italy manage respiratory diseases caused by work, finding gaps in collaboration that could be improved with shared guidelines and training.

## Contribution

The study identifies specific differences in diagnostic and therapeutic approaches between pulmonologists and occupational physicians, highlighting the need for integrated care in occupational respiratory disease management.

## Key findings

- Pulmonologists focus more on clinical diagnosis and pharmacotherapy, while occupational physicians emphasize occupational history and preventive measures.
- Interdisciplinary collaboration occurs only occasionally, indicating a significant gap in integrated care.
- Shared barriers include poor patient adherence and limited access to advanced diagnostic tools.

## Abstract

Background: Themanagement of occupational respiratory diseases (ORDs) requires a multidisciplinary approach, yet collaboration between pulmonologists and occupational physicians is often fragmented, potentially compromising patient outcomes. This study aimed to systematically compare the management strategies for ORDs between these two specialties in Italy to identify gaps and opportunities for integration. Methods: A cross-sectional survey was conducted using a structured 12-item questionnaire distributed to board-certified pulmonologists and occupational physicians across Italy. The questionnaire assessed diagnostic pathways, therapeutic strategies, preventive measures, and patterns of interdisciplinary collaboration. A total of 102 specialists (51 pulmonologists and 51 occupational physicians) completed the survey. Comparative analyses were performed using Pearson’s χ2 tests. Results: Significant divergences in practice were identified. Pulmonologists primarily focused on clinical diagnosis, utilizing pulmonary function tests (34.3%) and imaging (11.8%), and favored pharmacotherapy (27.5%) as the first-line treatment, in alignment with clinical guidelines. Conversely, occupational physicians prioritized detailed occupational and exposure histories (15.7%) and preventive interventions aimed at exposure reduction (15.7%). While both groups acknowledged the importance of collaboration, a substantial number reported that it occurred only occasionally (17.6% of pulmonologists and 12.7% of occupational physicians), indicating a significant gap in integrated care. Shared barriers included poor patient adherence and limited access to advanced diagnostic tools. Conclusions: While sharing a common foundation in diagnostic and preventive principles, pulmonologists and occupational physicians in Italy operate with distinct, complementary approaches that remain insufficiently integrated. The observed fragmentation in diagnostic and therapeutic pathways underscores an urgent need for shared national guidelines, structured interdisciplinary training, and formalized communication protocols. Bridging this disciplinary divide is essential to delivering holistic care, optimizing worker health, and preserving work ability.