Occupational Asthma Reference

Moore VC, Cullinan P, Sadhra S, Burge PS, Peak expiratory flow analysis in workers exposed to detergent enzymes, Occup Med, 2009;59:418-423,

Keywords: detergent enzymes, peak expiratory flow, Oasys, IgE, exposure

Known Authors

Paul Cullinan, Royal Brompton Hospital, London, UK Paul Cullinan

Sherwood Burge, Oasys Sherwood Burge

Vicky Moore, Oasys Vicky Moore

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Abstract

Aims
To study serial peak expiratory flow (PEF) responses in a group of symptomatic detergent enzyme-exposed workers.

Methods
Workers were recruited from a biological detergent formulating and packaging company. Those with occupational asthma symptoms and/or specific IgE to a detergent enzyme were asked to complete 2 hourly PEF measurements for 4 weeks. Outputs from the Oasys program (Oasys score, rest-work score and rest-work difference in diurnal variation) assessed PEF response. These were then related to the levels of sensitization and current occupational exposure to detergent enzymes.

Results
In all, 67/72 workers returned PEF records; 97% were able to return a record with at least four readings per day and 87% at least 3 weeks in length. Of total, 79% (n = 27) of those with a final diagnosis of occupational asthma had peak flow records confirming the disease using Oasys. PEF response was similar in those with high, medium and low levels of exposures and those with negative, low-moderate and high specific IgE levels.

Conclusions
The Oasys program is a sensitive tool for the diagnosis of detergent enzyme occupational asthma, but the levels of exposure and specific IgE sensitization to enzymes do not affect the magnitude of PEF response in symptomatic workers.

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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 67/72 workers returned PEF records; 97% were able to return a record with at least four readings per day and 87% at least 3 weeks in length
What are the sensitivity and specificity of serial measurements of peak flow in the diagnosis of occupational asthma?
burgeps In enzyme detergent workers 79% (n = 27) of those with a final diagnosis of occupational asthma had peak flow records confirming the diagnosis using the Oasys rest-work score >= 16l/min after day interpretation; for an Oasys-2 score of >2.5 sensitivity was 76%. The final diagnosis was based on a history of work-related asthma symptoms and positive IgE to detergent enzymes. The peak flow records were not used for the diagnosis of occupational asthma in this study (but was in the original report of this outbreak). Specificity could not be assessed as PEF records were not attempted in asymptomatic workers. (Using a clinical diagnosis including viewing the PEF records without Oasys plotting and incorporating some specific challenges the sensitivity of the Oasys-2 score >2.5 was 77%

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