Joanna Szram1,2, Bernadette Fitzgerald1,2, Susan Schofield1,2 and Paul
Cullinan1,2
1Occupational and
Environmental Medicine, Royal Brompton and Harefield NHS Foundation
Trust, London, United Kingdom, 2National Heart and Lung Institute,
Imperial College, London, United Kingdom
Specialist
referral of prospective firefighters declaring a history of asthma is
commonplace in the UK,typically including measurement of airway
reactivity using an indirect bronchial challenge, such as histamine
provocation testing. We present the clinic experience of our specialist
occupational lung disease service in the assessment of fitness to work
of firefighter applicants from across the UK. Between March 1999
– Jan 2016, 112 firefighters were seen from 11 regional fire
services, all referred for pre-employment evaluation because of a
history of previous or current asthma. The majority were male (87.8%,
n=79) and atopic on formal allergy testing (n=66, 77.7%). Mean FEV1 and
FVC were 98.7% and 108.4% predicted, respectively. Ninety applicants
underwent histamine testing; most (75.6%, n=68) had a normal response
(PC20>16 mg/ml) and an even greater proportion had a
“borderline normal” result (PC20>8 mg/ml;
n=77, 85.6%). Clinical data on 80 individuals showed that 33.8% (n=27)
of individuals experienced symptoms and a similar proportion (40%,
n=32) used asthma medication in the last 12 months. At the time of
review however, 65% were taking no asthma treatment; the majority of
applicants taking medication required reliever therapy only (n=20/31;
64.5%). A history of asthma remains a relative contraindication to
employment as a firefighter; the contemporary increase in the
prevalence of childhood asthma is now having an impact on the adult
workforce. Histamine provocation testing provides a convenient metric
for assessing airway reactivity. Follow up data on this cohort in terms
of performance at work has the potential to help further clarify the
approach to firefighter recruits with asthma.
