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Abstract
In 1956, the Board of Trustees of the American Medical Association convened an ad hoc Committee on Medical Rating of Physical Impairment that published thirteen articles in JAMA between 1958 and 1970, including one on pulmonary impairment rating on November 22, 1965. That article rated pulmonary impairment by radiographic abnormalities, the historical description of the degree of shortness of breath, the results of at least two of three spirometric tests (forced vital capacity, forced expiratory flow in one second, and the maximal ventilatory volume), the maximal ventilatory volume, and oxygen saturation (if performed). Use of the examinee's history has come full circle from being part of the impairment rating process to being excluded to being reintroduced in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. The concept that asthma is not easily rated using methods applicable to other pulmonary diseases was introduced in the fifth edition and was modified for use in the sixth edition. Since the publication of the fifth edition, several medications have been approved for treatment of asthma. Future editions likely will refine the medication usage table to reflect medications in clinical use at the time and, one hopes, also will eliminate the clumsy reference to “beclomethasone equivalents” and are likely instead to reference low, medium, and high doses of the inhaled corticosteroids.
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1.
Demeter SL. Introduction to disability and impairment. In: Demeter SL, Andersson GBJ, eds. Disability Evaluation. 2nd ed. St. Louis, MO: Mosby; 1996:3–7.
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Committee on Rating Mental and Physical Impairment. The respiratory system. JAMA. 1965;194:917–932.
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American Medical Association. Guides to the Evaluation of Permanent Impairment. 2nd ed. Chicago, IL: American Medical Association; 1984.
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Engleberg A, ed. Guides to the Evaluation of Permanent Impairment. 3rd ed. Chicago, IL: American Medical Association; 1988.
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American Medical Association. Guides to the Evaluation of Permanent Impairment. 3rd rev ed. Chicago, IL: American Medical Association; 1990.
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Doege TC, Houston TP, eds. Guides to the Evaluation of Permanent Impairment. 4th ed. Chicago, IL: American Medical Association; 1993.
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Evaluation of impairment/disability secondary to respiratory disease. A statement of the American Thoracic Society. Am Rev Respir Dis. 1982;126:945–951.
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Evaluation of impairment/disability secondary to respiratory disease. A statement of the American Thoracic Society. Am Rev Respir Dis. 1986;133:1205–1209.
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Chan-Yeung M. Evaluation of impairment/disability in patients with occupational asthma. Am Rev Respir Dis. 1987;135:950–951.
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Harber P. Assessing disability from occupational asthma. A perspective on the AMA Guides. Chest. 1990;98(suppl):232s–235s.
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Guidelines for the evaluation of impairment/disability in patients with asthma. A statement of the American Thoracic Society. Am Rev Respir Dis. 1993;147:1056–1061.
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Cocchiarella L, Andersson GBJ, eds. Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago, IL: American Medical Association; 2001.
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Rondinelli RD, ed. Guides to the Evaluation of Permanent Impairment. 6th ed. Chicago, IL: American Medical Association; 2008.
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14.
Demeter SL. Pulmonary impairment. In: Demeter SL, Andersson GBJ, eds. Disability Evaluation. 2nd ed. St. Louis, MO: Mosby; 1996:361–384.
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