Occupational Asthma Reference

Girard F, Chaboillez S, Cartier A, Côté J, Hargreave FE, Labrecque M, Malo JL, Tarlo SM, Lemière C, An effective strategy for diagnosing occupational asthma: use of induced sputum., Am J Respir Crit Care Med, 2004;170:845-850,
(Plain text: Girard F, Chaboillez S, Cartier A, Cote J, Hargreave FE, Labrecque M, Malo JL, Tarlo SM, Lemiere C, An effective strategy for diagnosing occupational asthma: use of induced sputum., Am J Respir Crit Care Med)

Keywords: diagnosis, induced sputum,

Known Authors

André Cartier, Hôpital de Sacré Coeur, Montreal, Quebec, Canada André Cartier

Jean-Luc Malo, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Jean-Luc Malo

Manon Labrecque, Hôpital de Sacre Coeur, Montreal, Quebec, Canada Manon Labrecque

Catherine Lemière, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Catherine Lemière

Susan Tarlo, Toronto Susan Tarlo

Freddy Hargreave, McMaster University, Hamilton Freddy Hargreave

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Abstract

Monitoring airway inflammation by means of induced sputum cell counts seems to improve the management of asthma. We sought to assess whether such monitoring at the end of periods at and away from work combined with the monitoring of PEF could improve the diagnosis of occupational asthma. We enrolled subjects suspected of having occupational asthma. Serial monitoring of PEF was performed during 2 weeks at and away from work. At the end of each period, induced sputum was collected. Specific inhalation challenge was subsequently performed. PEF graphs were interpreted visually by five independent observers. Forty-nine subjects, including 23 with positive specific inhalation challenge, completed the study. The addition of sputum cell counts to the monitoring of PEF increased the specificity of this test, respectively, by 18 (range [r] 13.7-25.5) or 26.8% (r 24.8-30.4) depending if an increase of sputum eosinophils greater than 1 or 2% when at work was considered as significant. The sensitivity increased by 8.2% (r 4.1-13.4) or decreased by 12.3% (r 3.1-24.1) depending on the cutoff value in sputum eosinophils chosen (greater than 1 or 2%, respectively). The addition of sputum cell counts to PEF monitoring is useful to improve the diagnosis of occupational asthma.

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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 feasibility of obtaining serial measurements of peak flow in workers suspected of having occupational asthma?
burgeps
Can experts agree on the interpretation of serial measurements of peak flow in the diagnosis of occupational asthma?
burgeps
What are the sensitivity and specificity of serial measurements of peak flow in the diagnosis of occupational asthma?
burgeps
burgeps Study of workers investigated by specific challenge in Canada, 45/94 excluded. Unable to perform specific challenge 9/94, unable to induce sputum 7/94, uninterpretable pef 3/49, no induced sputum 1/49. Symptom scores showed large changes between work and rest, similar in challenge positive and negative subjects, raising possibilities of low sensitivity of specific challenge. Similar improvement 9about one doubling) in PC20 in challenge positive and negative workers. Eosinophils in induced sputum showed reduced changes in those on ICS. Increase in sputum eosinophils >1% sensitivity 65.2% specificity 76%; Increase in sputum eosinophils >2% sensitivity 52% specificity 80%; Increase in sputum eosinophils >6.4% sensitivity 26.1% specificity 92%; PEF analysis likely to be of reduced quality records as only 2 complexes; sensitivity 34.8 by Oasys, specificity 65.2%. addins sputon eosinophils increasing by >1 or 2% increased sensitivity to 50% and 36.4% (specificities 75 and 80%). Expert agreement of PEF records poor (Cohens Kappa 0.4-0.6). This is a difficult paper to turn into evidence. All modalities performed poorly compared with specific challenge, specific challenge performed poorly compared with symptom diaries. Sputum eosinophilia normal in at least some with positive challenges (fig 1) probably about 50% of those with positive challenges. Results inadequate to support use of induced sputum as part of diagnostic work-up

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