Occupational Asthma Reference

Moore VC, Jaakkola MS, Burge CBSG, Pantin CFA, Robertson AS, Burge PS, Shift work effects on serial PEF measurements for occupational asthma, Occup Med, 2012;62:525-532,

Keywords: Oasys, shiftwork, diagnosis, occupational asthma, method, diurnal variation, ABC,

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Charles Pantin, Keele, UK Charles Pantin

Vicky Moore, Oasys Vicky Moore

Cedd Burge, Oasys Cedd Burge

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Maritta Jaakkola, Oulu University Finland Maritta Jaakkola

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Abstract

Background
Diurnal variation (DV) affects lung function but the changes are thought to be related to sleep patterns rather than time of day. When diagnosing occupational asthma (OA), serial peak expiratory flow (PEF) measurements are the recommended first line investigation, but could be confounded by shift work.

Aims
The aim of the study was to investigate the effects of shift work on PEF measurements used for diagnosing OA.

Methods
PEF records containing more than one shift pattern with =4 days per shift were identified. OA diagnosis was based on an Oasys-2 score =2.51 and non-OA on having an alternative clinical diagnosis and Oasys-2 score <2.51. The mean area between curves (ABC) score, mean PEF DV and cross-shift PEF changes were calculated for each shift.

Results
Records from 123 workers with OA and 69 without OA satisfied inclusion criteria. In the OA group, PEF declined more on afternoon and night shifts than days (P < 0.001). The ABC score was lower in the OA group on night (P < 0.05) and afternoon shifts (P < 0.05) as compared with days, without significant differences in DV. Among those without OA, cross-shift PEF increased more on day shifts (mean + 25 l/min) than afternoon or night shifts (+1 l/min) (P < 0.001). The sensitivity for the ABC score and DV were good and similar across shifts, but specificity was reduced using DV (DV mean 39%; ABC 98%).

Conclusions
PEF responses between work and rest show small differences according to shift type. The ABC score has a high sensitivity and specificity for all shifts; differences in DV have lower specificity.

Plain text: Background Diurnal variation (DV) affects lung function but the changes are thought to be related to sleep patterns rather than time of day. When diagnosing occupational asthma (OA), serial peak expiratory flow (PEF) measurements are the recommended first line investigation, but could be confounded by shift work. Aims The aim of the study was to investigate the effects of shift work on PEF measurements used for diagnosing OA. Methods PEF records containing more than one shift pattern with >=4 days per shift were identified. OA diagnosis was based on an Oasys-2 score >=2.51 and non-OA on having an alternative clinical diagnosis and Oasys-2 score <2.51. The mean area between curves (ABC) score, mean PEF DV and cross-shift PEF changes were calculated for each shift. Results Records from 123 workers with OA and 69 without OA satisfied inclusion criteria. In the OA group, PEF declined more on afternoon and night shifts than days (P < 0.001). The ABC score was lower in the OA group on night (P < 0.05) and afternoon shifts (P < 0.05) as compared with days, without significant differences in DV. Among those without OA, cross-shift PEF increased more on day shifts (mean + 25 l/min) than afternoon or night shifts (+1 l/min) (P < 0.001). The sensitivity for the ABC score and DV were good and similar across shifts, but specificity was reduced using DV (DV mean 39%; ABC 98%). Conclusions PEF responses between work and rest show small differences according to shift type. The ABC score has a high sensitivity and specificity for all shifts; differences in DV have lower specificity.

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What are the sensitivity and specificity of serial measurements of peak flow in the diagnosis of occupational asthma?
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