Fate of grainhandlers with bronchial hyperreactivity

Bronchial reactivity to methacholine and to grain dust were determined in a group of grainhandlers whose spirometry was being studied prospectively. Six workers showed specific bronchial responses to grain dust (indicative of occupational asthma), 21 did not show reactivity to grain dust but had bronchial hyperreactivity to methacholine and 40 had neither. Those with hyperreactivity were older, had lower FEV1 at initial examination and were more likely to experience a significant decline in FEV1 over a single working shift. Over 6 years of follow-up, those with hyperreactivity were not more likely to leave work and although they showed a more rapid decline in lung function over the period, because of the small number of individuals studied the difference between those with and without bronchial hyperreactivity was not significant. Among those with hyperreactivity to methacholine, there was a significant positive association between change in FEV1 over a single workshift and change in FEV1 over six years of followup, not seen in those without hyperreactivity to methacholine. Moreover, reactivity to methacholine was a stable observation over 6 years in the majority of studied individuals. We conclude that in the presence of bronchial hyperreactivity to methacholine, change in FEV1 over a single workshift more precisely predicts the trend in FEV1 over time in grainhandlers.