{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:44:58Z","timestamp":1772163898754,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","issue":"8","funder":[{"name":"Alcoa of Australia Ltd"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the predictive value of bronchial hyper-responsiveness (BHR) for the subsequent development of respiratory symptoms, airflow limitation and decline in lung function among aluminium smelter workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An inception cohort study of new employees at two Australian aluminium smelters was conducted. Participants completed a modified British Medical Research Council respiratory questionnaire, spirometry and a methacholine bronchial challenge test at baseline and at annual follow-up reviews. BHR was defined as PD\n                      <jats:sub>20<\/jats:sub>\n                      \u22644000\u2009\u00b5g. Poisson and mixed effects models were fitted to respiratory symptoms and lung function (forced expiratory volume in 1\u2009s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ) and FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/forced vital capacity (FVC)).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline interview and lung function testing were completed by 278 workers, who were followed for a median of 4 years. BHR at baseline, present in 82 workers, was not associated with incident wheeze risk ratio (RR)=1.07 (95% CI 0.74 to 1.55) and cough RR=0.78 (95% CI 0.45, 1.35), but there was some increased risk of chest tightness RR=1.40 (95% CI 0.99, 1.98) after adjustment for age, sex, smoking and atopy. BHR at baseline was associated with lower FEV\n                      <jats:sub>1<\/jats:sub>\n                      and FVC, although the rate of annual decline in FEV\n                      <jats:sub>1<\/jats:sub>\n                      or FVC was similar between those with or without BHR. The specificity of BHR was 77% for wheeze, 70% for cough and 77% for chest tightness, but the sensitivity was poor, at 33%, 24% and 39%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Methacholine challenge testing at entry to employment was not sufficiently predictive of later adverse respiratory outcomes, and notwithstanding the study limitations is unlikely to be a useful pre-employment or preplacement screening test in the aluminium smelting industry.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/oemed-2019-106344","type":"journal-article","created":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T18:05:14Z","timestamp":1586282714000},"page":"535-539","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Predictive value of non-specific bronchial challenge testing for respiratory symptoms and lung function in aluminium smelter workers"],"prefix":"10.1136","volume":"77","author":[{"given":"Michael J","family":"Abramson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0295-4575","authenticated-orcid":false,"given":"Stella May","family":"Gwini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas H","family":"de Klerk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9352-0552","authenticated-orcid":false,"given":"Anthony","family":"Del Monaco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martine","family":"Dennekamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7692-3560","authenticated-orcid":false,"given":"Lin","family":"Fritschi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Dimitriadis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammadreza","family":"Mohebbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur William (Bill)","family":"Musk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm Ross","family":"Sim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,4,7]]},"reference":[{"key":"2020071412251152000_77.8.535.1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1164\/ajrccm\/139.4.1042","article-title":"Does aluminum smelting cause lung disease?","volume":"139","author":"Abramson","year":"1989","journal-title":"Am Rev Respir Dis"},{"key":"2020071412251152000_77.8.535.2","doi-asserted-by":"publisher","DOI":"10.1136\/oem.2009.046458"},{"key":"2020071412251152000_77.8.535.3","unstructured":"Ferguson G , Hopkins R , Poortinga K , et al . Systematic review of occupational aluminium exposure and adverse health conditions. Mississauga, Ontario, Canada: Intrinsik Corp, 2017."},{"key":"2020071412251152000_77.8.535.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.jom.0000197876.31901.f5"},{"key":"2020071412251152000_77.8.535.5","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/144.1.10"},{"key":"2020071412251152000_77.8.535.6","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqv158"},{"key":"2020071412251152000_77.8.535.7","first-page":"77","article-title":"The use of bronchial provocation tests for identifying asthma: a review of the problems for occupational assessment and a proposal for a new direction","volume":"3","author":"Freed","year":"2002","journal-title":"ADF Health"},{"key":"2020071412251152000_77.8.535.8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0088"},{"key":"2020071412251152000_77.8.535.9","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.3.9701113"},{"key":"2020071412251152000_77.8.535.10","first-page":"422","article-title":"Histamine provocation test: an effective pre-employment selection method for aluminium workers","volume":"83","author":"De Looff","year":"1992","journal-title":"Med Lav"},{"key":"2020071412251152000_77.8.535.11","unstructured":"Medical Research Council . 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