Farnham J E
Department of Occupational and Environmental Medicine, University of Texas Health Center at Tyler 75708-3154, USA.
Tex Med. 1999 Oct;95(10):60-4.
The seriousness of asthma in the general population has been recognized by increased prevalence, morbidity, and mortality rates in the past 20 years. The effects of occupational asthma on health and productivity in the workplace have been so deleterious that the Occupational Safety and Health Administration targeted 1995 as a crisis year for effective remediation. Several risk factors have been identified, but all asthma is multifactorial. Inhaled chemical, physical, and microbiological agents in the form of dust, fumes, gases, and vapors may cause workplace asthma, which is mediated through pharmacologic, immunologic, or irritant mechanisms. Because of the complexity of these mechanisms after exposure to the offending agents, the clinical manifestations may be classed as immediate, delayed, or dual responses. Evaluating causation and relationship to work requires a thorough history (including detailed job description), physical examination, and definitive studies to determine the presence of bronchospasm, bronchial hyperreactivity, atopy, work-relatedness, and presence of specific sensitization. Goals of treatment for occupational asthma are to maintain pulmonary function as close to normal as possible, to maintain a normal lifestyle, and to prevent exacerbation. In occupational asthma, particularly, the patient (or the inciting cause, if known) should be removed from the offending environment as soon as possible. Specific treatment depends upon the specific offending agent, and antiasthma therapy may be needed following the guidelines of the National Heart, Lung, and Blood Institute.
在过去20年中，哮喘在普通人群中的严重性已通过患病率、发病率和死亡率的增加而得到认可。职业性哮喘对工作场所的健康和生产力产生了极其有害的影响，以至于美国职业安全与健康管理局将1995年定为有效补救的危机年份。已经确定了几个风险因素，但所有哮喘都是多因素的。以粉尘、烟雾、气体和蒸汽形式存在的吸入性化学、物理和微生物制剂可能导致职业性哮喘，其通过药理、免疫或刺激机制介导。由于接触致病因子后这些机制的复杂性，临床表现可分为即刻反应、延迟反应或双重反应。评估病因及与工作的关系需要详细的病史（包括详细的工作描述）、体格检查以及确定支气管痉挛、支气管高反应性、特应性、与工作的相关性和特异性致敏存在的确定性研究。职业性哮喘的治疗目标是尽可能使肺功能维持在接近正常水平，维持正常生活方式，并预防病情加重。特别是在职业性哮喘中，应尽快让患者（或已知的致病原因）脱离致病环境。具体治疗取决于具体的致病因子，可能需要按照美国国立心肺血液研究所的指南进行抗哮喘治疗。
