Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
First published online on March 30, 2007
Chest, doi:10.1378/chest.06-2218
doi:10.1378/chest.06-2218
(Chest. 2007; 131:1760-1767)
© 2007 American College of Chest Physicians
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow All Versions of this Article:
chest.06-2218v1
131/6/1760    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (2)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miedinger, D.
Right arrow Articles by Leuppi, J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miedinger, D.
Right arrow Articles by Leuppi, J. D.

Diagnostic Tests for Asthma in Firefighters*

David Miedinger, MD; Prashant N. Chhajed, MD, FCCP; Michael Tamm, MD; Daiana Stolz, MD; Christian Surber, PhD and Jörg D. Leuppi, MD, PhD

* From the Clinic for Pneumology (Drs. Miedinger, Chhajed, Tamm, Stolz, and Leuppi) and Hospital Pharmacy (Dr. Surber), University Hospital, Basel, Switzerland.

Correspondence to: David Miedinger, MD, Department of Internal Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland; e-mail: miedingerd{at}uhbs.ch

Abstract

Background: Subjects with asthma do not meet medical requirements for professions such as firefighting.

Objective: To prospectively determine the diagnostic value of respiratory symptoms and various tests used in the assessment of asthma in a cohort of firefighters.

Methods: A questionnaire, spirometry, direct and indirect airway challenge tests, exhaled nitric oxide, and skin-prick tests were administered prospectively to 101 of 107 firefighters employed in Basel, Switzerland. Asthma was defined as the combination of respiratory symptoms with airway hyperresponsiveness.

Results: Six of 101 firefighters (6%) had physician-diagnosed asthma, which could be confirmed in 4 firefighters. In contrast, asthma was diagnosed in 14% (14 of 101 firefighters). Wheezing was the most sensitive symptom for the diagnosis of asthma (sensitivity, 78%; specificity, 93%). Other respiratory symptoms showed a higher specificity than wheezing but a markedly lower sensitivity. Bronchial airway challenge with mannitol was the most sensitive (92%) and specific (97%) diagnostic test for asthma. Using a cutoff point of 47 parts per billion, nitric oxide had a similar specificity (96%) but lower sensitivity (42%) compared to the direct (methacholine) and indirect (mannitol) airway challenge tests.

Conclusion: Asthma was considerably underdiagnosed in firefighters. The combination of a structured symptom questionnaire with a bronchial challenge test allows to identify patients with asthma and should routinely be used in the assessment of active firefighters and may be of help when evaluating candidates for this profession.

Key Words: asthma test • exhaled nitric oxide • firefighters • mannitol • methacholine • skin prick test






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the American College of Chest Physicians.