Lung function, bronchial hyperresponsiveness, and atopy among firefighters

OBJECTIVES: The aim of this study was to determine associations between lung function, bronchial hyperresponsiveness (BHR), and atopy with exposure to fire smoke among firefighters. METHODS: The study was comprised of 402 firefighters, a randomly chosen subset of a previous survey among firefighters in the Netherlands. Subjects underwent spirometry and methacholine provocation, and blood samples were taken to assess atopy. Exposure to fire smoke was registered by a questionnaire. RESULTS: Hyperresponsiveness expressed as dose-response slope (DRS) was positively and significantly associated with the number of fires fought in the last 12 months with and without adjustments for smoking, gender, atopy, age, and exposure in the main job held. Limiting the analysis to firefighters without exposure within 7 days of testing did not change any of the associations. The association between the number of fires and the DRS was stronger among atopics, and hyperresponsiveness expressed as PD (20)was also significantly associated, indicating that atopics are at higher risk of developing BHR as a result of smoke exposure. Respiratory protection devices were not optimally used. CONCLUSIONS: It is recommended that awareness be heightened among firefighters to avoid exposure to all fire smoke and that management be sensitive to the adequate use of self-contained breathing apparatuses by their personnel

Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation

BACKGROUND: Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic. OBJECTIVE: To develop diagnostic models predicting baker's asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic. METHODS: As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker's asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure. RESULTS: The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (≥10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients. CONCLUSION: The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history

Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation

BACKGROUND: Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic. OBJECTIVE: To develop diagnostic models predicting baker's asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic. METHODS: As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker's asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure. RESULTS: The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (≥10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients. CONCLUSION: The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history

Lung function, bronchial hyperresponsiveness, and atopy among firefighters

Objectives The aim of this study was to determine associations between lung function, bronchial hyperresponsiveness (BHR), and atopy with exposure to fire smoke among firefighters. Methods The study was comprised of 402 firefighters, a randomly chosen subset of a previous survey among firefighters in the Netherlands. Subjects underwent spirometry and methacholine provocation, and blood samples were taken to assess atopy. Exposure to fire smoke was registered by a questionnaire. Results Hyperresponsiveness expressed as dose-response slope (DRS) was positively and significantly associated with the number of fires fought in the last 12 months with and without adjustments for smoking, gender, atopy, age, and exposure in the main job held. Limiting the analysis to firefighters without exposure within 7 days of testing did not change any of the associations. The association between the number of fires and the DRS was stronger among atopics, and hyperresponsiveness expressed as PD(20) was also significantly associated, indicating that atopics are at higher risk of developing BHR as a result of smoke exposure. Respiratory protection devices were not optimally used. Conclusions It is recommended that awareness be heightened among firefighters to avoid exposure to all fire smoke and that management be sensitive to the adequate use of sell-contained breathing apparatuses by their personnel

What are the benefits of medical screening and surveillance?

Pre-employment examination is considered to be an important practice and is commonly performed in several countries within the European Union. The benefits of medical surveillance programmes are not generally accepted and their structure is often inconsistent. The aim of this review was to evaluate, on the basis of the available literature, the usefulness of medical screening and surveillance. MEDLINE was searched from its inception up to March 2010. Retrieved literature was evaluated in a peer-review process and relevant data was collected following a systematic extraction schema. Pre-placement screening identifies subjects who are at an increased risk for developing work-related allergic disease, but pre-employment screening is too low to be used as exclusion criteria. Medical surveillance programmes can identify workers who have, or who are developing, work-related asthma. These programmes can also be used to avoid worsening of symptoms by implementing preventive measures. A combination of different tools within the surveillance programme, adjusted for the risk of the individual worker, improves the predictive value. Medical surveillance programmes provide medical as well as socioeconomic benefits. However, pre-employment screening cannot be used to exclude workers. They may act as a starting point for surveillance strategies. A stratified approach can increase the effectiveness and reduce the costs for such programmes