Can serial FEV1 identify work-related asthma cases missed by serial peak expiratory flow

Details

• Personal Author:
  Burge CB ; Burge PS ; Cox-Ganser, Jean M. ; Henneberger, Paul K. ; Liang X ; Moore VC
• Description:
  Background: Existing analyses to identify work-related asthma (WRA) using serial peak expiratory flow (PEF) include the area between the curve (ABC) score that characterizes the difference between summary curves of hourly PEF on rest days and work days. The cutoff value for WRA using the PEF-ABC score is 15 liters/minute/hour (l/min/hr). Many portable devices that measure serial PEF also concurrently measure and record the forced expiratory volume in one second (FEV1). Serial FEV1 might facilitate the identification of WRA cases, although currently there are no validated criteria to judge work-related status using this metric. We used serial spirometry data from adults with asthma to examine whether ABC scores based on FEV1 (FEV1-ABC) might identify the same or different WRA cases as those implicated by PEF-ABC scores. Methods: The study sample comprised 95 working adults with asthma who were enrolled in a health maintenance organization in the US state of Massachusetts and participated in a study of asthma. Each participant completed at least two weeks of self-testing using a portable spirometer that recorded and time/date stamped PEF and FEV1. We calculated PEF-ABC scores and applied the existing cutoff point of 15 l/min/hour for a positive work-related status, which was fulfilled by 7 participants. Without validated criteria to interpret FEV1-ABC scores, we compared the participants with the 7 highest FEV1-ABC scores (>=0.06 l/hour) to the group of 7 with PEF-ABC scores >=15. Results: The 95 asthma cases were 71% female with a mean age of 34 years, and worked predominantly in management, professional, and business (48%) and sales and office (28%) occupations. Their PEF-ABC values ranged from -50 to +50 with median=-1.97, and FEV1-ABC values ranged from -0.33 to +0.26 with median=-0.04. The two groups (n=7 in each) with high ABC scores shared 4 participants in common. The three cases with evidence for WRA based only on an elevated PEF-ABC score were in the 9th (n=1) and 8th (n=2) deciles of FEV1-ABC scores. The three cases with evidence for WRA based only on an elevated FEV1-ABC score were in the 10th, 8th, and 3rd deciles of PEF-ABC scores. Conclusion: Serial FEV1 might help to identify WRA cases when used in conjunction with serial PEF. However, further work is needed to establish and validate criteria for WRA using serial FEV1. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Diagnosis Lung Diseases Occupational Health Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Airway-obstruction Analytical-instruments Analytical-processes Breathing Bronchial-asthma Diagnostic-techniques Diagnostic-tests Humans Lung-disorders Measurement-equipment Pulmonary-function-tests Pulmonary-system-disorders Respiration Respiratory-system-disorders Spirometry

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• ISSN:
  1073-449X
• Document Type:
  Text
• Genre:
  Abstract or Summary
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DRDS - Division of Respiratory Disease Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  189
• NIOSHTIC Number:
  nn:20044696
• Citation:
  Am J Respir Crit Care Med 2014 May; 189(Meeting Abstracts):A4594
• Contact Point Address:
  P. K. Henneberger, CDC, National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV
• Email:
  pkh0@cdc.gov
• Federal Fiscal Year:
  2014
• Peer Reviewed:
  False
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Meeting Abstracts
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:70aeaf697528c2cfd09be7ce56600b83eeb2bfb1081eb698ee2ed77e16d4626d9a0efd0a22c07739e9c7fe20aaddc793c3fa9041830bb3a99fafdf24d511de9e
• Download URL:
  https://stacks.cdc.gov/view/cdc/200340/cdc_200340_DS1.pdf
• File Type:
  [PDF - 19.34 KB ]