Reference

Perrin B, Lagier F, L'Archeveque J, Cartier A, Boulet LP, Cote J, Malo JL, Occupational Asthma: Validity Of Monitoring Of Peak Expiratory Flow Rates And Non-Allergic Bronchial Responsiveness As Compared To Specific Inhalation Challenge, Eur Respir J, 1992;5:40-8,

BOHRF Original Authors' Main Conclusions

The original authors' main conclusions are taken from Abstract, Results and Discussion. They are decided upon by the authors of the BOHRF occupational asthma guidelines and form part of the guidelines.

Peak expiratory flow rates (PEFR) was assessed every 2 h in 61 subjects referred for occupational asthma during a period away from work for at least 2 weeks. 3 experienced readers interpreted graphs of PEFR and PC20 values blindly. There was complete agreement among the experts in 54/61 cases. 25/61 subjects (41%) had positive specific inhalation challenge (SIC). The best index for comparing results of PEFR with SIC was the visual analysis of PEFR with sensitivity and specificity of 81% and 74%. Authors conclude that visual analysis of PEFR is an interesting tool for investigating occupational asthma, although sensitivity and specificity values do not seem satisfactory enough to warrant using it alone.

The following comments are from the editors of the BOHRF occupational asthma guidelines and form part of the guidelines.

12 occupational asthma cases had normal BHR

BOHRF Associated Evidence Statements

The BOHRF occupational asthma guidelines state that this reference is associated with the following evidence statements

There is high level of agreement between expert interpretations of serial peak flow records.

The sensitivity and specificity of serial peak flow measurements are high in the diagnosis of occupational asthma

Statistical analysis of serial peak flow measurements is of limited diagnostic value compared to expert interpretation

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2++

A large number of concordant studies from different centres using different methodologies demonstrated that increased non-specific reactivity is often found in workers with occupational asthma. There are however many reports of normal methacholine or histamine reactivity within 24 hours of exposure in workers with confirmed occupational asthma.

Changes in non-specific reactivity at and away from work alone have only moderate sensitivity and specificity for diagnosis.

Non Bohrf Information

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