Occupational Asthma Reference

Bolen AR, Henneberger PK, Liang X, Sama SR, Preusse PA, Rosiello RA, Milton DK, The validation of work-related self-reported asthma exacerbation, Occup Environ Med, 2007;64:343-348,

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Known Authors

Don Milton, Harvard Don Milton

Paul Henneberger, NIOSH, Morgantown, USA Paul Henneberger

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Abstract

Objective: To determine the validity of work-related self-reported exacerbation of asthma using the findings from serial peak expiratory flow (PEF) measurements as the standard.

Methods: Adults with asthma treated in a health maintenance organisation were asked to conduct serial spirometry testing at home and at work for 3 weeks. Self-reported respiratory symptoms and medication use were recorded in two ways: a daily log completed concurrently with the serial PEF testing and a telephone questionnaire administered after the PEF testing. Three researchers evaluated the serial PEF records and judged whether a work relationship was evident.

Results: 95 of 382 (25%) working adults with asthma provided adequate serial PEF data, and 13 of 95 (14%) were judged to have workplace exacerbation of asthma (WEA) based on these data. Self-reported concurrent medication use was the most valid single operational definition, with a sensitivity of 62% and a specificity of 65%.

Conclusions: A work-related pattern of self-reported asthma symptoms or medication use was usually not corroborated by serial PEF testing and failed to identify many people who had evidence of WEA based on the serial PEF measurements.

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Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

What is the frequency of occupational asthma?
burgeps The study tried to contact 382 employed adults identified from those insured with a community health plan in Massachusetts, USA for clinic spirometry followed by 3 weeks diary cards and 2-hourly spirometry using the Easy-1 logging spirometer. 47% completed clinic spirometry, of these 78 provided some measures of serial PEF (36% of whole group) and 53% provided PEF data suitable for the evaulation of occupational asthma using Oasys. 13/95 had PEF evidence of occupatio0nal asthma (14% of those with adequate records, 3.4% of total group).
What is the feasibility of obtaining serial measurements of peak flow in workers suspected of having occupational asthma?
burgeps Records using the Easy-1 logging spirometer, suitable for Oasys intrepretation, were obtained from 53% of a community sample of asthmatics attending a research clinic (78% providing some records). 53% of the total sample did not attend the reseach clinic and were not offered PEF monitoring leaving adequate recods from 25% of the intended sample. Patients were paid $200 for completing the study.
What is the sensitivity and specificity of respiratory questionnaires in the diagnosis of validated cases of occupational asthma?
burgeps The study compared real-time diary cards of current symptoms and bronchodilator use with a telephone interview after the completion of diary cards. There was a poor correlation between questions asking for asthma symptoms or or bronchodilator treatment improving away from work and the diary card assessments. Asthma symptoms reported retrospectively improving away from work sensitivity 15%; specificity 87%. Less bronchodilators on restdays sensitivity 15% and specificity 89%. Using contemporary diary card data symptoms sensitivity 62%, specificity 54%; bronchodilator usage sensitivity 62%, specificity 65%. The comparitor was serial PEF measurements showing occupational asthma.

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Comments

The study tried to contact 382 employed adults identified from those insured with a community health plan in Massachusetts, USA for clinic spirometry followed by 3 weeks diary cards and 2-hourly spirometry using the Easy-1 logging spirometer. 47% completed clinic spirometry, of these 78 provided some measures of serial PEF (36% of whole group) and 53% provided PEF data suitable for the evaulation of occupational asthma using Oasys. 13/95 had PEF evidence of occupatio0nal asthma (14% of those with adequate records, 3.4% of total group). There was a poor correlation between contemporary diary card symptoms and bronchodilator use captured on the Easy-1 spirometer and a telephone administered retrospective questionnaire.
There are lots of ways of interpreting this data. Assuming that those attending the clinic and completing PEF measurements were representative of all those insured asthmatics, occupational asthma was validated in 13% of insured adult asthmatics.
4/18/2008

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