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,
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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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.
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