Follow-up survey of patients with occupational asthma.

BACKGROUND: Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual's career and income can be significant. AIMS: We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. METHODS: Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. RESULTS: We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8-48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. CONCLUSIONS: The negative impact of OA on people's careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health

Assessment and outcomes of firefighter applicants with possible asthma.

BACKGROUND: Firefighter applicants (FFAs) with a history of asthma may be refused entry to the fire service because of potentially putting themselves and others at risk. AIMS: We undertook a service evaluation to identify respiratory and employment outcomes of FFAs with a history of asthma who had undergone additional respiratory assessment at our specialist occupational lung disease clinic during 2005-19. METHODS: We reviewed FFA medical records and categorized them as having either no current asthma or definite/probable asthma at the time of clinic assessment. 'No current asthma' was defined as negative non-specific bronchial hyper-responsiveness (BHR) to histamine/methacholine, and no symptoms or treatment within the 2 years before clinic. 'Definite/probable current asthma' was defined as either positive BHR, or negative BHR with symptoms and/or treatment within the previous 2 years. Around 1 year later, we contacted FFAs to enquire about their application outcome and current respiratory symptoms. RESULTS: Data were available on 116 applicants; of whom, 45% (n = 52) had definite/probable current asthma and were significantly more likely to be older, atopic to common aeroallergens, report atopic disease and have a lower forced expiratory volume in one second/forced vital capacity ratio compared with applicants with no current asthma. Only two individuals' applications were rejected due to asthma. At follow-up, just 2 (2%) of the 90 operational firefighters reported any recent trouble with asthma. CONCLUSIONS: A history of asthma alone is not sufficient to determine current asthma in FFAs. Even with a diagnosis of current asthma, FFAs are mostly successful in their application to join the fire service

S108 Outcomes of firefighter applicants with a history of asthma

Introduction Firefighters work in a ‘safety critical role’ and undergo comprehensive pre-employment screening. Applicants with a history of asthma (often made in childhood) are regularly referred to our specialist occupational lung disease service for additional assessment including measurement of non-specific bronchial hyper-responsiveness (NSBHR). No studies have reported the impact of a pre-existing asthma diagnosis on future employment as a firefighter; most have studied current firefighters1 or others in safety critical roles.2 We sought to identify factors associated with a positive NSBHR test amongst UK firefighter applicants, and to link these to symptoms and employment status around one year later. Methods We reviewed case notes for all firefighter applicants referred between 2005–2019; we defined NSBHR as a fall in FEV1 of at least 20% (provocation concentration (PC)20) following inhalation of <8 mg/ml histamine. Around one year after their initial appointment we contacted them for follow up, including enquiring about their application outcome and current respiratory symptoms. Results Clinical data were available on 120 applicants of whom 19 (16%) had a positive NSBHR test (see table 1). Follow-up data were available on 116 applicants. Those with a positive NSBHR test (n=17; 14.7%) were less likely to be accepted into the fire service than those with a negative test (76.5% vs 95.0% respectively, p=0.026). However, of the 4 with a positive NSBHR and not accepted by the fire service, only 2 were due to asthma. Of the 90 serving firefighters at follow-up, only 2 (2.2%) reported any recent trouble with asthma