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.
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.