title: A descriptive analysis of asthma in the U.S. Navy Submarine Force.
abstract: BACKGROUND
  The U.S. Navy Submarine Force offers a unique opportunity to study asthma because of the relative socioeconomic and physical homogeneity of the population and the closed environment occupational exposure. Currently, asthma is disqualifying from submarine service, which results in a significant loss of experienced personnel.
  
  
  METHODS
  We performed a retrospective analysis of 119 U.S. Navy submariner disqualification packages for asthma between 1989-1993.
  
  
  RESULTS
  We found a 0.16% annual period prevalence of asthma in the active duty enlisted Atlantic Fleet Submarine Force. Two groups of asthma disqualifications were identified with a significant increase above their proportional representation in the fleet: enlisted personnel (p < 0.01) and submarine recruits (p < 0.0001). The proportion of African-American personnel also had a tendency toward increased asthma disqualification (p < 0.08). There were no differences in prevalence of asthma between crews of ballistic missile submarines or fast attack submarines. Asthma risk factors reported in the civilian literature (childhood history of asthma, family history of asthma and non-drug allergies) were highly represented in our study (41%, 46% and 68% of submariners, respectively). Most disqualified submariners had "mild" asthma based on the diagnostic work-up. The methacholine challenge test appeared to carry a disproportionate diagnostic weight despite its low specificity.
  
  
  CONCLUSIONS
  Although the period prevalence of asthma is low in the U.S. Navy Submarine Force, submariners disqualified for asthma have similar historical and ethnic risk factors as the civilian population.
authors.affiliation: Naval Submarine Medical Research Laboratory, Naval Submarine Base New London, Groton, CT 06349, USA. Sims@nsmrl.navy.mil
authors.forename: J R
authors.initials: JR
authors.lastname: Sims
authors.forename: P M
authors.initials: PM
authors.lastname: Tibbles
authors.forename: R P
authors.initials: RP
authors.lastname: Jackman
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016085:Bronchoconstrictor Agents; D004185:Disability Evaluation; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D016210:Methacholine Chloride; D008889:Military Personnel / Q000706:statistics & numerical data*; D015995:Prevalence; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012882:Skin Tests; D012959:Socioeconomic Factors; D013147:Spirometry; D013366:Submarine Medicine; D014481:United States / Q000453:epidemiology
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride