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Diagnosis of occupational asthma from serial measurements of forced expiratory volume in 1 s (FEV1) using the Area Between Curves (ABC) score from the Oasys plotter
  1. Edward D Parkes1,
  2. Vicky C Moore2,
  3. Gareth I Walters2,
  4. Peter Sherwood Burge2
  1. 1 Department of Respiratory Sciences, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2 Occupational Lung Disease Service, University Hopitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Edward D Parkes, Respiratory Sciences, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; Edward.parkes{at}


Objectives To identify the changes in serial 2-hourly forced expiratory volume in 1 s (FEV1) measurements required to identify occupational asthma (OA) using the Oasys Area Between Curves (ABC) score.

Methods The ABC score from 2-hourly measurements of FEV1 was compared between workers with confirmed OA and asthmatics without occupational exposure to identify the optimum separation using receiver operator characteristic (ROC) analysis. Separate analyses were made for plots using clock time and time from waking to allow for use in shift workers. Minimum record criteria were ≥6 readings per day, >4 day shifts and >4 rest days (or >9 days for controls).

Results A retrospective analysis identified 22 workers with OA and 30 control asthmatics whose records reached the quality standards. Median FEV1 diurnal variation was 20.3% (IQR 16.1–32.6) for OA and 19.5% (IQR 14.5–26.1) for asthmatic controls. ROC curve analysis identified that a difference of 0.056 L/hour gave a ROC score of 0.821 for clock time and 0.768 for time from waking with a sensitivity of 73% and a specificity of 93% for the diagnosis of OA.

Conclusions The diagnosis of OA requires objective confirmation. Unsupervised serial FEV1 measurements are more difficult to obtain reliably than measurements of peak expiratory flow, which are likely to remain the standard for general use. A FEV1 ABC score >0.056 L/hour provides a valid cut-off for those who wish to use FEV1 rather than peak expiratory flow.

  • occupational asthma
  • asthma
  • occupational health practice
  • computers and information technology

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  • Contributors EDP, PSB, GW and VCM planned the study and wrote the paper. EDP and VCM performed the analysis. PSB 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 PSB and VCM have developed with others the Oasys analytical system used in this paper. It is open access on without payment or qualification.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the East Birmingham REC 06/Q2703/73.

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

  • Data availability statement Data are available on reasonable request. Data are stored at Birmingham Heartlands Hospital, Occupational Lung Disease Unit, Bordesley Green East Birmingham, UK on a secure local repository. Data are available on request to the corresponding author.