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Development and validation of a diagnostic tool for occupational asthma based on serial lung function measurements

Moore, Vicky Clare (2010)
Ph.D. thesis, University of Birmingham.

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Serial peak expiratory flow measurements (PEF) are recommended as an initial investigation in the confirmation of occupational asthma. Plotting measurements in Oasys gives reproducible results and can be used by non-experts. I report a new analysis, the area between curves (ABC) score, which gives 72% sensitivity and 100% specificity using a cut off of 15 L/min/h. Two-hourly measurements of PEF require 8 work days and 3 rest days for sensitive and specific analysis. Serial PEF records with long periods off work (≥ 4 consecutive days) show improved sensitivity from 73% to 80%, implying that 7 more workers in every 100 would be diagnosed. In a comparison of forced expiratory volume in one second (FEV1) to PEF, PEF was more sensitive to diurnal changes than FEV1, although FEV1 was more reproducible. Exhaled breath nitric oxide (FENO) showed similar ABC scores between those with normal and raised FENO. FENO was significantly correlated to methacholine reactivity. In shift workers, mean ABC scores were increased on morning shifts compared to nights, but the cut off of 15 L/min/h would be applicable across all shift types. The ABC score is a new robust method of confirming occupational asthma requiring shorter records than the Oasys score.

Type of Work:Ph.D. thesis.
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Health and Population Sciences, Institute of Occupational and Environmental Medicine
Subjects:RA0421 Public health. Hygiene. Preventive Medicine
Institution:University of Birmingham
ID Code:1094
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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