IS THE CLINICAL HISTORY A SATISFACTORY MEANS OF DIAGNOSING OCCUPATIONAL ASTHMA

被引:188
作者
MALO, JL
GHEZZO, H
LARCHEVEQUE, J
LAGIER, F
PERRIN, B
CARTIER, A
机构
[1] Department of Chest Medicine, Hopital du Sacre-Coeur, Montreal, Que.
来源
AMERICAN REVIEW OF RESPIRATORY DISEASE | 1991年 / 143卷 / 03期
关键词
D O I
10.1164/ajrccm/143.3.528
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
In some countries a diagnosis of occupational asthma for medicolegal purposes is made when a questionnaire is suggestive and the individual is exposed to a product known to be a sensitizer. The value of an open questionnaire administered by physicians with experience in occupational asthma is unknown, however. We prospectively assessed all subjects (162) referred to our clinic because their physicians thought their asthma might be work related. The medical questionnaire included questions about the nature of the symptoms (dyspnea, wheezing, cough, and chest tightness) and the timing (worse at work or after a shift at work or improved during weekends or holidays). An initial clinical assessment was set by the physician on a scale that ranged from highly probable to probable, uncertain, unlikely, or absent. Subjects then underwent objective assessment with specific inhalation challenges (n = 72), serial monitoring of peak expiratory flow rates for periods at work and away from work (n = 29), or both (n = 61), to confirm or rule out the diagnosis of occupational asthma. A total of 75 subjects (46%) were shown to have occupational asthma. Symptoms alone (type and timing) did not provide a satisfactory differentiation between those subjects with and those without occupational asthma. For example, 66 of 75 (88%) subjects with occupational asthma said that their symptoms improved during holidays, but 66 of 87 (76%) subjects without occupational asthma experienced a similar improvement. Based on the initial clinical assessment, it was found that the predictive value of a history that suggested that occupational asthma was highly probable or probable was 63% (65 of 104), whereas the predictive value of a history indicating that occupational asthma was unlikely or absent was 83% (19 of 23). These figures suggest that an open medical questionnaire is not a satisfactory means of diagnosing occupational asthma. Objective means should also be used.
引用
收藏
页码:528 / 532
页数:5
相关论文
共 32 条
  • [1] ADELROTH E, 1986, AM REV RESPIR DIS, V134, P704
  • [2] [Anonymous], 1987, Am Rev Respir Dis, V136, P1285
  • [3] ROLE OF INHALATION CHALLENGE TESTING IN THE DIAGNOSIS OF ISOCYANATE-INDUCED ASTHMA
    BANKS, DE
    SASTRE, J
    BUTCHER, BT
    ELLIS, E
    RANDO, RJ
    BARKMAN, HW
    HAMMAD, YY
    GLINDMEYER, HW
    WEILL, H
    [J]. CHEST, 1989, 95 (02) : 414 - 423
  • [4] BARDY JD, 1987, AM REV RESPIR DIS, V135, P1033
  • [5] REACTIVE AIRWAYS DYSFUNCTION SYNDROME (RADS) - PERSISTENT ASTHMA SYNDROME AFTER HIGH-LEVEL IRRITANT EXPOSURES
    BROOKS, SM
    WEISS, MA
    BERNSTEIN, IL
    [J]. CHEST, 1985, 88 (03) : 376 - 384
  • [6] OCCUPATIONAL ASTHMA IN AN ELECTRONICS FACTORY
    BURGE, PS
    PERKS, W
    OBRIEN, IM
    HAWKINS, R
    GREEN, M
    [J]. THORAX, 1979, 34 (01) : 13 - 18
  • [7] PEAK FLOW-RATE RECORDS IN THE DIAGNOSIS OF OCCUPATIONAL ASTHMA DUE TO COLOPHONY
    BURGE, PS
    OBRIEN, IM
    HARRIES, MG
    [J]. THORAX, 1979, 34 (03) : 308 - 316
  • [8] OCCUPATIONAL ASTHMA DUE TO INHALED CARMINE
    BURGE, PS
    OBRIEN, IM
    HARRIES, MG
    PEPYS, J
    [J]. CLINICAL ALLERGY, 1979, 9 (02): : 185 - 189
  • [9] PEAK FLOW-RATE RECORDS IN THE DIAGNOSIS OF OCCUPATIONAL ASTHMA DUE TO ISOCYANATES
    BURGE, PS
    OBRIEN, IM
    HARRIES, MG
    [J]. THORAX, 1979, 34 (03) : 317 - 323
  • [10] BURNEY PGJ, 1989, EUR RESPIR J, V2, P940