Wasif Anees1. 1. Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, England.
Abstract
OBJECTIVE: To discuss the different methods of assessing lung function measurements for the diagnosis of occupational asthma, focusing in particular on serial peak expiratory flow rate (PEFR) monitoring, including details on how PEFR records should be kept, plotted, and analyzed and limitations of the method. DATA SOURCES: Published studies on the use of diagnostic methods in occupational asthma, expert opinion, and recently obtained data from studies performed at a large occupational lung disease clinic. STUDY SOURCES: The expert opinion of the author was used to select the relevant data for review. RESULTS: Objective methods are necessary for the diagnosis of occupational asthma, since clinical history alone is not a satisfactory means of diagnosis. Serial PEFR monitoring has a high diagnostic sensitivity and specificity for occupational asthma and is more useful than evaluation of cross-shift change in forced expiratory volume in 1 second or change in nonspecific bronchial hyperresponsiveness. Interpretation is best performed by expert visual evaluation of plots of maximum, mean, and minimum daily PEFR readings. CONCLUSIONS: Despite some limitations of the method, serial PEFR monitoring is usually the most appropriate first-line investigation in workers suspected of having occupational asthma.
OBJECTIVE: To discuss the different methods of assessing lung function measurements for the diagnosis of occupational asthma, focusing in particular on serial peak expiratory flow rate (PEFR) monitoring, including details on how PEFR records should be kept, plotted, and analyzed and limitations of the method. DATA SOURCES: Published studies on the use of diagnostic methods in occupational asthma, expert opinion, and recently obtained data from studies performed at a large occupational lung disease clinic. STUDY SOURCES: The expert opinion of the author was used to select the relevant data for review. RESULTS: Objective methods are necessary for the diagnosis of occupational asthma, since clinical history alone is not a satisfactory means of diagnosis. Serial PEFR monitoring has a high diagnostic sensitivity and specificity for occupational asthma and is more useful than evaluation of cross-shift change in forced expiratory volume in 1 second or change in nonspecific bronchial hyperresponsiveness. Interpretation is best performed by expert visual evaluation of plots of maximum, mean, and minimum daily PEFR readings. CONCLUSIONS: Despite some limitations of the method, serial PEFR monitoring is usually the most appropriate first-line investigation in workers suspected of having occupational asthma.
Authors: Aimee R Bolen; Paul K Henneberger; Xiaoming Liang; Susan R Sama; Peggy A Preusse; Richard A Rosiello; Donald K Milton Journal: Occup Environ Med Date: 2006-12-20 Impact factor: 4.402
Authors: Lora E Fleming; Barbara Kirkpatrick; Lorraine C Backer; Judy A Bean; Adam Wanner; Dana Dalpra; Robert Tamer; Julia Zaias; Yung Sung Cheng; Richard Pierce; Jerome Naar; William Abraham; Richard Clark; Yue Zhou; Michael S Henry; David Johnson; Gayl Van De Bogart; Gregory D Bossart; Mark Harrington; Daniel G Baden Journal: Environ Health Perspect Date: 2005-05 Impact factor: 9.031