title: Diagnostic tests for asthma in firefighters.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinic for Pneumology, University Hospital, Basel, Switzerland. miedingerd@uhbs.ch
authors.forename: David
authors.initials: D
authors.lastname: Miedinger
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.forename: Christian
authors.initials: C
authors.lastname: Surber
authors.forename: Jörg D
authors.initials: JD
authors.lastname: Leuppi
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D015331:Cohort Studies; D004608:Eligibility Determination; D005390:Fires; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D011446:Prospective Studies; D018635:Rescue Work; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013147:Spirometry; D000078329:Workforce
chemical_list: D009569:Nitric Oxide