Can clinical history be used to predict the outcome of fitness assessment for occupational pressure exposure in persons with a history of childhood asthma?
Author: Scutt, M
Year: 2018
Active asthma is a bar to diving in the Armed Forces, as it may increase accident rates. Childhood asthma is a condition that may enter remission with a risk of subsequent relapse. The Institute of Naval Medicine assesses potential divers whose medical history includes childhood asthma. This assessment includes outsourced pulmonary function testing. It may be possible to exclude applicants whose history indicates a high likelihood of being found unfit, prior to being sent for pulmonary function testing. This would allow more effective use of scarce resources.
A retrospective cohort study was conducted. Subjects were all personnel referred to the Institute of Naval Medicine for assessment with a history of childhood asthma between 1983 and 2016. The cohort was taken from the database of fitness decisions held at the Institute. Information on identified prognostic indicators of childhood asthma (smoking status, age at onset, age at remission, hospitalisations and courses of oral steroids arising from asthma, and a history of hayfever or eczema) was taken from the database of fitness decisions. Missing data was taken from the electronic health record where such was available.
Persons with a history of hospitalisation or with a history of hayfever were significantly less likely to be found fit for pressure exposure (hospitalisation p=0.019, OR=0.033; hayfever p=0.019, OR=0.442). Persons who were found unfit at assessment tended to be younger at onset of asthma (p=0.065) and were significantly older at remission (p=0.028) than their peers who were found fit.
Factors prognostic of poor outcome in childhood asthma may also be prognostic of likely failure to be found fit for occupational pressure exposure. However, further research is required before a predictive model can be constructed.
