Do subjects investigated for occupational asthma through serial peak expiratory flow measurements falsify their results?☆,☆☆,★,★★
Section snippets
Subjects
The data kept for analysis came from 21 prospectively recruited subjects who attended a specialized occupational asthma clinic and who met the following criteria: at least 2 weeks of PEF monitoring at work and 2 weeks away from work in the case of subjects with a diagnosis of occupational asthma and at least 2 weeks of PEF monitoring at work in the case of subjects without a confirmed diagnosis of occupational asthma. Patients were either referred by their general practitioner or a specialist
RESULTS
Some of the baseline anthropometric, clinical, and functional results are listed in Table I. The majority of subjects were men under 55 years of age and taking either no medication or an inhaled β2-adrenergic agent only as needed. The most commonly incriminated agents at work were isocyanates (hexamethylene diisocyanate only) among spray painters in body shops and flour among bakers. A diagnosis of occupational asthma was retained in eight subjects, of personal asthma in five subjects, and of
DISCUSSION
This study shows that the compliance with PEF monitoring in the investigation of occupational asthma was poor in our sample of 21 asthmatic subjects prospectively assessed. Subjects were asked to record three PEF values eight times per day for a mean duration of 36 days. This is the method for which we previously showed a sensitivity of 81% and a specificity of 74%.7 At least 6048 values should have been recorded and stored in the VMX apparatus (this excludes some values, which should have been
Acknowledgements
We thank Katherine Tallman for reviewing the manuscript.
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How many times per day should peak expiratory flow rates be assessed when investigating occupational asthma?
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Cited by (74)
Reply
2016, Journal of Allergy and Clinical ImmunologyAsthma in the Workplace
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionClinical Assessment of Occupational Asthma and its Differential Diagnosis
2011, Immunology and Allergy Clinics of North AmericaCitation Excerpt :On one hand, PEF may greatly underestimate or overestimate changes in airway caliber as assessed by FEV1.35–37 On the other hand, they are effort dependent and, thus, require the cooperation of the worker, which is not always obtained because of the fear of losing his or her job or malingering to gain compensation benefits.38,39 The combination of NABR monitoring and PEF monitoring at work and off work is now frequently used in the investigation of OA.
Occupational agents
2009, Asthma and COPDOccupational Agents
2008, Asthma and COPD: Basic Mechanisms and Clinical ManagementThe diagnosis and management of occupational asthma
2008, Revue des Maladies Respiratoires
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From the Department of Chest Medicine, Hôpital du Sacré-Couer, Montreal. Dr. Malo is a research fellow with the Fonds de la Recherche en Santé du Québec and the Université de Montréal School of Medicine.
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Supported in part by the Centre Québécois d’excellence en santé respiratoire.
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Reprint requests: Jean-Luc Malo, MD, Department of Chest Medicine, Hôpital du Sacré-Couer, 5400 W. Gouin, Montreal, Canada H4J 1C5.
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