Chest
Clinical InvestigationsPeak Expiratory Flow Rates in Possible Occupational Asthma
Section snippets
Materials and Methods
Patients were selected from the files of consecutive workers referred for assessment of possible occupational asthma. They were all seen in the occupational asthma clinics of the Cage Research Institute and the Toronto General Hospital between 1978 and 1988 by one of us (S.M.T.) using the same diagnostic approach throughout, as previously described.10
A full history of all subjects included occupational exposure, information on any known spills or unusually high exposures, respiratory symptoms,
Demographic Characteristics
The demographic characteristics are summarized in Table 1; the majority of the patients were men, about one half were atopic, and isocyanates were the most frequent exposure agent. All patients had a history consistent with occupational asthma. The prevalence of OA (based on the objective diagnoses) was 18 (36 percent) among the 50 eligible patients. Consensus discussion was needed to settle initial disagreement between the observers for 12 of the 50 records. Table 2 shows the overall
Discussion
This study has demonstrated that explicit criteria for the interpretation of peak flow tracings can be developed with acceptable interobserver variation, as demonstrated by the moderately high kappa values.
ACKNOWLEDGMENTS
The authors thank Drs. I. Broder and G. J. Stopps for their helpful comments.
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Cited by (46)
Diagnosis and management of work-related asthma: American College of Chest Physicians consensus statement
2008, ChestCitation Excerpt :For example, for a 5-day work week, a significant diurnal variation occurring on 10 of 15 working days, on only 2 of 6 days off work on weekends, and 2 of 14 days off work would be a positive response. This technique gave a sensitivity of 93% and a specificity of 90% in diagnosing sensitizer-induced OA among those persons from whom PEFRs could be fully interpreted.104 A more sophisticated method of analysis is based on a computer-generated discriminant analysis (OASYS-2; OASYS Research Group, Midland Thoracic Society; Birmingham, UK) that is commercially available and uses a different method of plotting results (Fig 6).
Comparison of peak expiratory flow variability between workers with work-exacerbated asthma and occupational asthma
2007, ChestCitation Excerpt :A Student t test was used to compare the PEF variability between subjects with OA and WEA. We also interpreted PEF records by using criteria previously described.16 We assessed the frequency of days where there was a ≥ 20% diurnal variation in PEF and determined the number of work days when this occurred, divided by the number of work days when the recordings were made.
Control chart for monitoring occupational asthma
2006, Journal of Safety ResearchUse of pulmonary function tests in the diagnosis of occupational asthma
2003, Annals of Allergy, Asthma and ImmunologyOccupational asthma
2002, Medical Clinics of North America
Manuscript received May 11; revision accepted November 12.
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From the Health Studies Service, Ontario Ministry of Labour, University of Toronto, Toronto, Canada
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Gage Research Institute and Toronto General Hospital