title: Asthma tests in the assessment of military conscripts.
abstract: BACKGROUND
  Respiratory diseases such as asthma may affect individuals' fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms at conscription, objective and reliable tests are needed.
  
  
  OBJECTIVE
  To prospectively determine the diagnostic value of the mannitol and methacholine bronchial provocation test (BPT) as well as exhaled nitric oxide in assessing physician-diagnosed asthma in a group of Swiss Armed Forces conscripts.
  
  
  METHODS
  Questionnaire, spirometry, BPT with methacholine and mannitol, exhaled nitric oxide (FeNO) and skin prick testing were conducted in 18-20-year-old male conscripts. Asthma was diagnosed by a military physician not involved in this study according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication.
  
  
  RESULTS
  Two hundred and eighty four subjects participated in the study. Complete data for the BPT with methacholine, mannitol and measurement of FeNO were available on 235 subjects. Forty-two conscripts (17.9%) had physician-diagnosed asthma. The sensitivity/specificity of mannitol to identify physician-diagnosed asthma was 41%/93% and for methacholine it was 43%/92%. Using a cut-off point of 36.5 p.p.b., FeNO had a similar negative predictive value to rule out physician-diagnosed asthma as BPT with mannitol or methacholine.
  
  
  CONCLUSIONS
  BPT with mannitol has a sensitivity and specificity similar to methacholine for the diagnosis of physician-diagnosed asthma in military conscripts but is less costly to perform without the need to use and maintain a nebulizer.
authors.affiliation: University Hospital, Basel, Switzerland. dmiedinger@uhbs.ch
authors.forename: D
authors.initials: D
authors.lastname: Miedinger
authors.forename: N
authors.initials: N
authors.lastname: Mosimann
authors.forename: R
authors.initials: R
authors.lastname: Meier
authors.forename: C
authors.initials: C
authors.lastname: Karli
authors.forename: P
authors.initials: P
authors.lastname: Florek
authors.forename: F
authors.initials: F
authors.lastname: Frey
authors.forename: K
authors.initials: K
authors.lastname: Scherer
authors.forename: C
authors.initials: C
authors.lastname: Surber
authors.forename: B
authors.initials: B
authors.lastname: Villiger
authors.forename: F
authors.initials: F
authors.lastname: Michel
authors.forename: J D
authors.initials: JD
authors.lastname: Leuppi
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D016210:Methacholine Chloride / Q000008:administration & dosage; D008889:Military Personnel; D009569:Nitric Oxide / Q000008:administration & dosage / Q000032:analysis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012882:Skin Tests; D011795:Surveys and Questionnaires; D013557:Switzerland; D055815:Young Adult
chemical_list: D016210:Methacholine Chloride; D009569:Nitric Oxide; D008353:Mannitol