P107 ASTHMA IN FIRE FIGHTERS AND RECRUITS

J Szram, L Tucker, J Arbery, J Cannon, S Upchurch, P Cullinan. Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK

Current guidelines for the recruitment of prospective firefighters essentially preclude the employment of those with asthma; but suggest specialist referral in certain cases, with a possible role for bronchial challenge, such as histamine provocation testing. Disability discrimination legislation requires all applicants for a post to be assessed on an individual basis. We present the clinic experience of our specialist occupational lung disease clinic in the assessment of fitness to work for firefighter applicants from across the UK. In addition, new cases of asthma in current firefighters are assessed in order to determine any occupational precipitating or exacerbating factors.

In the period 2000–8 48 firefighters were seen from 11 regional fire services. 43 were male, their mean age was 34 years. 24 (21 male, mean age 28 years) were referred for pre-employment assessment due to a history of previous or current asthma. Of these, 11, in whom there was some clinical suspicion of current bronchial hyperresponsiveness, underwent histamine provocation testing, of whom nine demonstrated a normal response (PC20 >16 mg/ml) and two had a borderline result (PC20a <16 mg/ml but >8 mg/ml).

A history of “asthma” is currently a relative or absolute contraindication to employment as a firefighter; the evidence-base that this is necessary is weak. Nonetheless the impact of the recent large increase in the prevalence of childhood asthma is now having an effect on the prospective workforce. The development of evidence-informed guidance is underway to help to clarify the approach to these issues.

P108 AIRWAY DYSFUNCTION IN NASAL POLYPOSIS: NO EVIDENCE OF THE “NON-ALLERGIC UNIFIED AIRWAY”

PA Williamson, S Vaidyanathan, M Barnes, K Clearie, BJ Lipworth. University of Dundee, Dundee, UK

Introduction and Objectives: It has been proposed that there is evidence of lower airways …