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Original research
Identification of late asthmatic reactions following specific inhalation challenge
  1. Vicky C Moore,
  2. Gareth Iestyn Walters,
  3. Alastair S Robertson,
  4. P Sherwood Burge
  1. Occupational Lung Disease Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Vicky C Moore, Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK; vicky.c.moore{at}


Specific inhalation challenge (SIC) is the reference standard for the diagnosis of occupational asthma. Current guidelines for identifying late asthmatic reactions are not evidence based.

Objectives To identify the fall in forced expiratory volume in 1 s (FEV1) required following SIC to exceed the 95% CI for control days, factors which influence this and to show how this can be applied in routine practice using a statistical method based on the pooled SD for FEV1 from three control days.

Methods Fifty consecutive workers being investigated for occupational asthma were asked to self-record FEV1 hourly for 2 days before admission for SIC. These 2 days were added to the in-hospital control day to calculate the pooled SD and 95% CI.

Results 45/50 kept adequate measurements. The pooled 95% CI was 385 mL (SD 126), or 14.2% (SD 6.2) of the baseline FEV1, but was unrelated to the baseline FEV1 (r=0.06, p=0.68), or gender, atopy, smoking, non-specific reactivity or treatment before or during SIC. Thirteen workers had a late asthmatic reaction with ≥2 consecutive FEV1 measurements below the 95% CI for pooled control days, 4/13 had <15% and 9/13 >15% late fall from baseline. The four workers with ≥2 values below the 95% CI all had independent evidence of occupational asthma.

Conclusion The pooled SD method for defining late asthmatic reactions has scientific validity, accounts for interpatient spirometric variability and diurnal variation and can identify clinically relevant late asthmatic reactions from smaller exposures. For baseline FEV1 <2.5 L, a 15% fall is within the 95% CI.

  • occupational asthma
  • lung function
  • sensitisers

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  • Presented at The paper has not been submitted elsewhere in any form, but has been presented at the December 2018 BTS meeting.

  • Contributors All authors contributed to the planning of the study. VCM conducted most of the challenge tests, with some conducted by GIW. VCM provided the statistics. All contributed to the reporting of the study. PSB wrote the first version of the paper and is the overall guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was given by North East—Newcastle & North Tyneside 2 Research Ethics Committee Reference 17/NE/0144.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The deidentified participant data are available on reasonable request from ORCID identifier: 0000-0003-1595-4053.