Questionnaires for clinical and epidemiological purposes

1. Questionnaires for clinical and epidemiological purposes Manon Labrecque,M.D., M.Sc.

2. Role of Epidemiology in OA • « The discipline of Epidemiology focus on the distribution and determinants of Health-related states and disease in population.” • The determinants are in 2 broad headings • Environmental and host factors • In the context of OA, the Environmental factors are thoses encountered in the work place

3. Work-Relatedness of Airway Disease • ILO suggested the use of following categories • (1) conditions caused by agent-specific exposures • (2) conditions of multifactorial etiology in wich work exposure is one of them • (3) conditions to which an individual is susceptible,and the disease is precitated by a work-related exposure • (4)preexisting conditions aggravated by a work-related exposure (1) Occupation diseases (2-3-4) work-related disease

4. Outcomes measurements in epidemiological studies of OA • Questionnaire: Advantage of being non invasive and easy to administer and appropriate for population studies • Standardized questionnaire for asthma has been developed and validated in international comparisons Ref: Burney PGJ Eur Respir J 1989;2:940-945

5. Questionnaires • Limitation • Poor correlation between symptoms and presence or absence of NSBR • NSBR can exist without symptoms • Asymptomatic subjects with NSBR can develop symtoms in subsequent years • Sensitivity and specificity in predicting asthma or OA are variable • Subjects can under or overreport their symptoms depending the circumstances

6. Questionnaire • From differents Studies we learned that the % of workers proven to be suffering from OA by specific challenge test or peak flow rate recording varies from 2 to 16% Thus, the questionnaire is a sensitive tool but not a specific one and while invaluable in etiological epidemiological studies in population at riks for OA,it is inadequate on its own for clinical case identification

7. Algorithm for Case Identification Questionnaire Skin or Skin or IT not Feasible immunological testing Feasible Negative Positive Assessment of NSBR Positive Specific Inhalation Tests and/ or PEFR monitoring

8. Asthma Questionnaire Asthma related questions were originally derived from the IUATLD bronchialsymptom questionnaire, and included a cluster of five questionsthat had exhibited the best combinationof sensitivity and specificity for the detection of NSBR (referred to as the "discriminantfunction predictor" or DFP). Ref: Burney PG. Int J Epidemiol. 1989 Mar;18(1):165-73.

9. Asthma Questionnaire These questions included (1)Have you ever had trouble with your breathing? (continuously or repeatedly) (2)Have you had an attack/episode of shortness of breath that came on following strenuous activity at any time in the last 12 months? (3)Have you had wheezing or whistling in your chest at any time in the last 12 months? (4)Have you been awakened during the night by an attack of the following symptom in the last 12 months: shortness of breath (5)When you are near animals, feathers, or in a dusty part of the house, do you ever get a feeling of tightness in your chest?

10. Asthma Questionnaire Have you had an attack of asthma in the last 12 months? Did a doctor ever tell you that you have asthma? Are you currently taking any medicine (including inhalers, aerosols or tablets) for asthma?

11. Occupationnal Asthma Questionnaire (1) Occupational exposure and history (2) General asthma questionnaire (Burney) (3) Symptoms in relation to the workplace (4) Non-occupational exposure related tocommon environmental aeroallergens and allergies (5) Family historyof atopy and asthma (6) Life-habits and smoking

12. Symptoms in relation to the workplace When you are at work, do you ever • 1. start to feel short of breath or get chest tightness? 2. start to cough? 3. start to wheeze? 4. related to your work do theses problems lessen or disappear during the weekend or during holidays?

13. Symptoms in relation to the workplace • Questions related to the presence ofeye and nasal symptoms were also included because they oftenaccompany respiratory symptoms, especially in the case of workplacehigh-molecular-weight proteinaceous agents

15. Questionnaire • typeof job, work shift and agents that the workers identified aspotential causes of symptoms; • the nature of symptoms duringworking periods, i.e. chest symptoms (cough, sputum, chest tightness,wheezing, shortness of breath at rest and/or on exertion, changein voice), general symptoms (fever, chills, muscle or jointpain), nasal symptoms (blocked nose, runny nose, sneezing, nasalor throat itching), eye symptoms (itching, runny eyes, rednessof the eyes), and skin symptoms (rash, eczema).

16. Questionnaire • timing of the onset of symptoms inrelation to the beginning of the occupation • the relationship between work and respiratory, nasal, conjunctivalor skin symptoms asking whether symptomsdiffered on days at work and away from work • whether there wasa specific product causing onset of symptoms • whether therewas an improvement in or disappearance of symptoms at weekendsand on vacation.

17. Questionnaire • The temporal pattern of asthmatic symptomswas also addressed (time interval necessary to develop symptomsafter starting work, persistence of symptoms after the workshift and presence of symptoms only on return from work).

20. In the currentstudy • Besides wheezing, nasal and ocular itching, runny nosewas significantly associated with the presence of OA due tohigh-molecular-weight agents (HMW). Loss of voice was more prevalentin subjects without OA, suggesting that upper airway dysfunctioncould be responsible for work-related respiratory symptoms insome subjects.

21. In the currentstudy • For low-molecular weight agents, no questionnaire itemwas found to be significantly predictive of the presence orabsence of OA. • (1) LMW agents cause nasoconjunctival symptomsless often than HMW • (2)LMW agents are chemicals that maymore easily cause nonspecific irritation of the airways withsymptoms in subjects with non-OA, making distinction betweenOA and work-aggravated asthma more difficult. (3)LMWagents causing OA often induce late asthmatic reactions that,contrary to immediate reactions, are more difficult to relatetemporarily to work.