转诊至医院肺功能实验室的非吸烟者的职业性吸入物暴露与呼吸系统疾病

Occupational inhalant exposure and respiratory disorders among never-smokers referred to a hospital pulmonary function laboratory.

作者信息

Mak G K, Gould M K, Kuschner W G

机构信息

Veterans Affairs Palo Alto Health Care System, and Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

出版信息

Am J Med Sci. 2001 Sep;322(3):121-6. doi: 10.1097/00000441-200109000-00002.

DOI:10.1097/00000441-200109000-00002

PMID:11570775

Abstract

BACKGROUND

Multiple reports have described associations between occupational inhalant exposure and lung disease. Previous occupational lung disease investigations have studied populations consisting of both smokers and nonsmokers. Smoking complicates interpretation of toxicant exposure-response relationships. The objective of this study was to determine whether, among never-smokers, occupational exposure to gases, dusts, or fumes is associated with a history of respiratory disorders and pulmonary function test defined obstructive lung disease.

METHODS

We performed a retrospective analysis of 517 never-smoker patients who underwent pulmonary function testing in our clinical laboratory between 1986 and 1999. We calculated the relative risks of developing adverse respiratory health outcomes given a history of exposure to occupational inhalants.

RESULTS

Compared with persons with a negative occupational exposure history, exposed persons had an increased risk of reporting a history of bronchitis [relative risk (RR), 1.59; 95% confidence interval (CI), 1.20-2.12], recurrent lung infections (RR, 2.09; 95% CI, 1.14-3.82), and bronchodilator use (RR, 1.61; 95% CI, 1.26-2.06). There was also a statistically significant association between a history of inhalant exposure and the finding of an obstructive ventilatory defect on pulmonary function testing (RR, 1.79; 95% CI, 1.12-2.85). A history of inhalant exposure was not associated with self-reported asthma (RR, 1.08; 95% CI, 0.83-1.41). The population attributable risk estimates for respiratory disorders due to inhalant exposure were: bronchitis, 23.6%; recurrent lung infection, 36.3%; bronchodilator use, 24.3%; and obstructive lung disease, 29.6%.

CONCLUSIONS

Occupational inhalant exposure is a strong risk factor for lung disease in this population of never smokers. A significant burden of respiratory disease in this population may be attributable to occupational inhalant exposure.

摘要

背景

多项报告描述了职业性吸入物暴露与肺部疾病之间的关联。以往的职业性肺部疾病调查研究的人群包括吸烟者和非吸烟者。吸烟使毒物暴露-反应关系的解释变得复杂。本研究的目的是确定在从不吸烟者中，职业性接触气体、粉尘或烟雾是否与呼吸系统疾病史及肺功能测试定义的阻塞性肺病有关。

方法

我们对1986年至1999年间在我们临床实验室接受肺功能测试的517名从不吸烟患者进行了回顾性分析。我们计算了有职业性吸入物暴露史的人出现不良呼吸健康结局的相对风险。

结果

与职业暴露史为阴性的人相比，暴露者报告支气管炎病史的风险增加[相对风险（RR），1.59；95%置信区间（CI），1.20 - 2.12]，反复肺部感染（RR，2.09；95% CI，1.14 - 3.82），以及使用支气管扩张剂（RR，1.61；95% CI，1.26 - 2.06）。吸入物暴露史与肺功能测试中阻塞性通气缺陷的发现之间也存在统计学上的显著关联（RR，1.79；95% CI，1.12 - 2.85）。吸入物暴露史与自我报告的哮喘无关（RR，1.08；95% CI，0.83 - 1.41）。吸入物暴露导致的呼吸系统疾病的人群归因风险估计为：支气管炎23.6%；反复肺部感染36.3%；使用支气管扩张剂24.3%；阻塞性肺病29.6%。