Source: Annual Congress 2010 - Occupational asthma
Disease area: Airway diseases

Abstract

Asthmatics undertaking emergency service work are thought to be at increased risk of severe bronchoconstriction with sudden exertion or exposure to irritants such as fire smoke, pepper spray or CS gas. The risks are poorly quantified and there are no clear guidelines to assist employers. We investigated the value of airway responsiveness measurements in 40 applicants to the police service who were thought to have asthma at a pre-employment examination. Their mean age was 25yr (SD 6yr); 22 (55%) were male. Only 15 (37%) reported active symptoms (wheeze, breathlessness or cough). Their median FEV1 was 106% of predicted and only 3 demonstrated airflow obstruction. Airway responsiveness was measured as PD20.FEV1 to methacholine using the Newcastle dosimeter technique (Stenton SC. et al, Occupational Med. 1993; 43: 203-206). 16 (40%) had measurements in the ‘definite‘ asthma range ie PD20.FEV1<200mug; 6 in the ‘equivocal‘ range PD20.FEV1<200-1000mug; and 18 in the ‘normal‘ range PD20.FEV1>1000mug. There was a clear relationship between pre-employment FEV1 and PD20 within the definite asthma group (F(1,14)= 9.15; p<0.001) but there were no significant associations between PD20 category and symptoms, medication use or lung function

Table 1

	n	Current symptoms	Preventer inhaler	Median FEV1
Definite asthma	16	8 (50%)	12 (75%)	106%
Equivocal asthma	6	1 (17%)	5 (83%)	109%
Normal	18	6 (33%)	10 (55%)	107%

We conclude that airway responsiveness measurements are practical in this setting and identify more than 50% of asthmatics as probably at low risk of marked bronchoconstriction. Further follow-up of the cohort will be necessary to more precisely determine the risks.

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Citations should be made in the following way:
S. Wiscombe, C. Stenton (Newcastle upon Tyne, United Kingdom). Airway responsiveness measurements in asthmatic recruits to emergency services. Eur Respir J 2010; 36: Suppl. 54, 1466

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