Can I just make a point that there no point in doing annual spirometry when the hazard is a sensitiser- at least in isolation.  There is a point in regular spirometry when the outcome you are looking for is accelerated decline in LF/COPD - so it is reasonable to do this in, say, mining or other dusty industries.  However, the point of respiratory health surveillance when the outcome is sensitisation is quite different - it is to pick up the earliest evidence of sensitisation.  In this context, changes in static lung function are very late consequences of inadequately managed asthma - and should never be seen, in theory.  In a perfect world, HS for sensitisation would include a symptoms questionnaire, a measure of immunological sensitisation, and a dynamic test of LF - eg a test of bronchial responsiveness or a peak flow record.  Economics, the lack of validated immunological tests for some important groups of sensitisers (eg isocyanates and solder fumes) and patient safety really do not allow any of these in a mass screening setting except symptoms.  So you need (1) to have a system that encourages people to come forward between routine HS appointments in order to have their symptoms picked up early and (2) a method of recording symptoms which picks up early symptoms.  Therefore, you really need to have face-to-face interviews with an experienced observer eg a qualified OHA in your sub-group with high risk eg your animal technicians.  And you need a short, sensitive questionnaire for the rest.  You can thrown in spirometry at the same time, if you like, but it is not necessary.  Where spirometry is ncessary is (1) at baseline and (2) as part of the investigation of acute symptoms - vital to have spirometry at the time someone is actually symptomatic with work-related cought/wheeze/chest tightness etc.

Kate
>>> [log in to unmask] 02/02/04 09:45:26 >>>
Hi,
The HSE have just "told us off " for overdoing the health surveillance
(we used to do 6/12 checks)  * that 0, 6 & 12 weeks then yearly
spirometry is fine for new exposure baseline surveillance, with annual
and one off baseline for previous exposure unless symptoms dictate
otherwise not risk. The HSE indicate all staff should be considered high
risk and monitored as above unless they are maintenance workers or
similar- in these cases once baseline has been achieved then yearly
questionnaires are adequate. So with the 0, 1, 3, 6 and 12 month routine
you could be making unnecessary work for yourself.

Car
 
-----Original Message-----
From: Amanda Dowson [mailto:[log in to unmask]] 
Sent: 02 February 2004 09:41
To: [log in to unmask] 
Subject: Re: Occ asthma -practical practice
 
Hi Diane/All
 
PEHA
We are informed on a workplace hazard sheet where job roles are working
with respiratory (or other) hazards. These workplace hazard sheets are
sent into Personnel with the request to recruit. The hazard sheets are
attached to the sealed envelope of the successful applicant. We
undertake the assessment and take baseline observations (initial
questionnaire and spiro). 
 
Follow on intro spiros are carried out at 1 month, 3 months, 6 months
and 12 months so that if someone reacts they are picked up quickly and
managed before they become irreversible. It also is useful for
emphasising need for H&S safe systems of work to be implemented and the
signs and symptoms to be reporting asap. 
 
Health Surveillance
 
Where no problems are identified, they are put on an annual review.
 
Where problems are identified, they are referred to the OP, we get them
to do 4 hourly peak flows (although compliance on the one occasion
poor). OP decides on management of case.
 
High risks
 
We havent got any but I would be increasing the health surveillance to 6
monthly for those who are id as high risk exposure - isocynates, animal
handlers etc.
 
Amanda
-----Original Message-----
From: diane romano woodward [mailto:[log in to unmask]] 
Sent: 30 January 2004 14:48
To: [log in to unmask] 
Subject: Occ asthma -practical practice
Dear All, 
I am sitting on a working party reviewing the evidence for detection
,health surveillance,  treatment etc for Occupational Asthma. We hope to
issue guidelines in September this year.
 
Meanwhile I would like to get a flavour of what people are actually
doing out there. If your employees are exposed to Sensitisers can you
give me some idea ,and also indicate why you have chosen to follow this
particular path:
 
Any information on your attitudes/practice to:
 
Pre employment issues
Health surveillance :baseline /early / annual?
paper screen , spirometry or both?
Action on finding a suspected case- removal from exposure,serial peak
flow, referral to specialist?
RIDDOR reporting? 
Does your practice differ with the different sensitisers, e.g. animal
exposure and chemical?
 
I will be having a good input into the leaflets that are produced for OH
professionals, and GP  and practice nurses.So I would like to know what
you would feel it would be valuable to have in them...
 Best wishes,
 
Diane
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