Occupational Asthma Reference

Vandenplas O, Ghezzo H, Munoz X, Moscato G, Perfetti L, Lemiere C, Labrecque M, L'Archeveque J, Malo JL, What are the questionnaire items most useful in identifying subjects with occupational asthma?, Eur Respir J, 2005;26:1056-1063,

Keywords: questionnaire, challenge,methods

Known Authors

Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

Jean-Luc Malo, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Jean-Luc Malo

Manon Labrecque, Hôpital de Sacre Coeur, Montreal, Quebec, Canada Manon Labrecque

Catherine Lemière, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Catherine Lemière

Giana Moscato, Fondazione Salvatore Maugeri, Pavia Giana Moscato

Xavier Munoz, Barcelona Xavier Munoz

Luca Perfetti, Fondazione Salvatore Maugeri, Pavia Luca Perfetti

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The present study assessed the usefulness of key items obtained from a clinical "open" questionnaire prospectively administered to 212 subjects, referred to four tertiary-care hospitals for predicting the diagnosis of occupational asthma (OA). Of these subjects, 72 (34%) were diagnosed as OA (53% with OA due to high-molecular-weight agents) according to results of specific inhalation challenges, and 90 (42%) as non-OA. Wheezing at work occurred in 88% of subjects with OA and was the most specific symptom (85%). Nasal and eye symptoms were commonly associated symptoms. Wheezing, nasal and ocular itching at work were positively, and loss of voice negatively associated with the presence of OA in the case of high-, but not low molecular-weight agents. A prediction model based on responses to nasal itching, daily symptoms over the week at work, nasal secretions, absence of loss of voice, wheezing, and sputum, correctly predicted 156 out of 212 (74%) subjects according to the presence or absence of OA by final diagnosis. In conclusion, key items, i.e. wheezing, nasal and ocular itching and loss of voice, are satisfactorily associated with the presence of occupational asthma in subjects exposed to high-molecular-weight agents. Therefore, these should be addressed with high priority by physicians. However, no questionnaire-derived item is helpful in subjects exposed to low-molecular-weight agents.

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Specificity of wheezing at work 85%, sensitivity 40%. Improvement weekends sensitivity 76% specificity 54%. Improvement holidays sensitivity 74$ specificity 57%.Loss of voice negatively associated with positice challenge. Predictive model set up and tested on same population, Unlikely to be generally valid as lack of nasal itching excludes OA at first step.

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