15 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (18)

The implications of the suggestion by Josephs and colleagues, if confirmed, include that histamine or methacholine hyperresponsiveness may not necessarily be present for the diagnosis of currently symptomatic asthma, in contrast to earlier reports. This could conceivably account for the low specificity that we observed in the present study. Perhaps the objective criteria suggesting no […]

14 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (17)

1. Peak flow tracings are useful both in the investigation of individual cases as in this study, but probably also in field studies for epidemiologic purposes as used by Smith et al. This modality is also inexpensive and noninvasive. A PEF interpretation of OA suggests a likely diagnosis of OA and should trigger or intensify […]

13 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (16)

Caution is required in interpreting these observations because the subgroups are quite small. Including indeterminate (a) in the rubric of OA makes the classification too lenient, mislabelling some normal subjects as diseased. The lenient classification is also reflected by the low specificity (too many false-positives), suggesting that stricter criteria, such as a longer study period […]

12 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (15)

The peak flow readings were instigated in a clinic setting, and over the years, involved the use of three different peak flowmeters in different patients. Different peak flowmeters are recognized to potentially differ in accuracy and reliability, as indicated in a study by Eichenhorn and colleagues which included two of the three types of peak […]

11 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (14)

Cot6 et al, using the results of plicatic acid challenge test as the gold standard, recently found PEFR recordings to have sensitivity and specificity of 86 and 89 percent, respectively, among 23 patients with suspected cedar asthma, values which are intermediate between ours and those of Burge et al. Cot6 et al “visually” analyzed the […]

10 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (13)

Interobserver Variation For the purposes of examining interobserver variation, the consensus interpretations are presented both for all subjects with interpretations of OA and the indeterminate OA (a) and (b) readings collapsed together (Table 5A), and with the indeterminate categories exluded (Table 5B). The kappa values were 61.7 percent overall, and 82.7 percent after the exclusions, […]

09 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (12)

Among those with a peak flow interpretation of “no asthma,” the negative predictive value was 77 percent; the objective diagnoses among those misinterpreted included OA, ? OA, and asthma (one subject each). Buy Advair Diskus Online Among the six subjects with a consensus interpretation of indeterminate (b), the objective diagnoses were ? OA (one subject), […]

08 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (11)

Among those with an objective diagnosis of “normal,” the specificity of the PEFR interpretations was only 53 percent, with incorrect interpretations of asthma (two subjects), OA (one subject), indeterminate (b) (two subjects), and (a) (four subjects). ampicillin antibiotic Sensitivity and Specificity Excluding Indeterminate Readings: Because we had concerns that peak flow interpretations of indeterminate readings […]

07 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (10)

Interobserver variation in interpretation could be determined for the final 31 eligible tracings and was assessed by means of the kappa statistic (Sackett et al); interpretations were collapsed into three categories as follow: asthma, OA, no asthma. antibiotics levaquin Because there was concern a priori that subjects with an indeterminate recording may differ from those […]

06 May

Peak Expiratory Flow Rates in Possible Occupational Asthma (9)

3.    Indeterminate readings: (a)    OA Category 2: if a ^20 percent change occurred on only one occasion. (b)    No diurnal variation exceeding 20 percent with ^20 percent change only longitudinally across days, with the lowest recordings on days at work (Fig lc). 4.    No asthma: None of the above (Fig Id). antibiotic levaquin For those […]

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