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S108 Outcomes of firefighter applicants with a history of asthma
  1. T Kabir1,
  2. S Schofield1,
  3. B Fitzgerald2,
  4. J Cannon2,
  5. J Szram1,2,
  6. P Cullinan1,2,
  7. J Feary1,2
  1. 1National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Royal Brompton and Harefield NHS Foundation Trust, London, UK


Introduction Firefighters work in a ‘safety critical role’ and undergo comprehensive pre-employment screening. Applicants with a history of asthma (often made in childhood) are regularly referred to our specialist occupational lung disease service for additional assessment including measurement of non-specific bronchial hyper-responsiveness (NSBHR).

No studies have reported the impact of a pre-existing asthma diagnosis on future employment as a firefighter; most have studied current firefighters1 or others in safety critical roles.2 We sought to identify factors associated with a positive NSBHR test amongst UK firefighter applicants, and to link these to symptoms and employment status around one year later.

Methods We reviewed case notes for all firefighter applicants referred between 2005–2019; we defined NSBHR as a fall in FEV1 of at least 20% (provocation concentration (PC)20) following inhalation of <8 mg/ml histamine. Around one year after their initial appointment we contacted them for follow up, including enquiring about their application outcome and current respiratory symptoms.

Results Clinical data were available on 120 applicants of whom 19 (16%) had a positive NSBHR test (see table 1).

Follow-up data were available on 116 applicants. Those with a positive NSBHR test (n=17; 14.7%) were less likely to be accepted into the fire service than those with a negative test (76.5% vs 95.0% respectively, p=0.026). However, of the 4 with a positive NSBHR and not accepted by the fire service, only 2 were due to asthma. Of the 90 serving firefighters at follow-up, only 2 (2.2%) reported any recent trouble with asthma.

Abstract S108 Table 1

Findings stratified by NSBHR test result (data are presented as n(%) unless otherwise stated. P-values are calculated excluding the ‘not recorded’ data)

Conclusions NSBHR is associated with atopy and a lower FEV1 but it was not otherwise possible to predict NSBHR. Although many applicants had a history of asthma and 16% a positive NSBHR result, encouragingly, only two individuals’ applications were rejected due to their asthma; individuals with a history of asthma should not be deterred from applying to become a firefighter. Specialist assessment may be useful in determining evidence of asthma amongst firefighter applicants prior to recruitment.


  1. Miedinger D. Chest, 2007;131:1760–1767.

  2. Miedinger D. Clinical & Experimental Allergy, 2010;40:224–231.

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