Youakim S
Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Am Fam Physician. 2001 Dec 1;64(11):1839-48.
Work-related asthma accounts for at least 10 percent of all cases of adult asthma. Work-related asthma includes work aggravation of preexisting asthma and new-onset asthma induced by occupational exposure. Occupational exposure to very high concentrations of an irritant substance can produce reactive airway dysfunction syndrome, while exposure to allergenic substances can result in allergic occupational asthma. An important step in the diagnosis of work-related asthma is recognition by the physician of the work relatedness of the illness. A thorough history can elucidate the work relation and etiology. Objective tests, including pulmonary function, nonspecific and specific bronchial hyperresponsiveness, serial peak expiratory flow rates, and skin allergies, should be performed to confirm the diagnosis of asthma and demonstrate a work correlation. Treatment for occupational asthma--use of anti-inflammatory medications such as inhaled steroids and bronchodilators--is the same as that for nonoccupational asthma. Prevention is an integral part of good medical management. In patients with work-aggravated or irritant-induced asthma, reduction of exposure to aggravating factors is essential. In patients with allergic occupational asthma, exposure should be eliminated because exposure to even minute concentrations of the offending agent can trigger a potentially fatal allergic reaction.
职业性哮喘至少占所有成人哮喘病例的10%。职业性哮喘包括原有哮喘的工作性加重以及职业暴露诱发的新发哮喘。职业暴露于高浓度刺激性物质可导致反应性气道功能障碍综合征，而暴露于变应原性物质可引发变应性职业性哮喘。诊断职业性哮喘的一个重要步骤是医生认识到疾病与工作的相关性。详尽的病史可阐明工作关系和病因。应进行客观检查，包括肺功能、非特异性和特异性支气管高反应性、连续呼气峰值流速以及皮肤过敏试验，以确诊哮喘并证明与工作的相关性。职业性哮喘的治疗——使用吸入性类固醇和支气管扩张剂等抗炎药物——与非职业性哮喘相同。预防是良好医疗管理的一个组成部分。对于工作性加重或刺激性诱发哮喘的患者，减少接触加重因素至关重要。对于变应性职业性哮喘患者，应避免接触，因为即使接触微量的致病因子也可能引发潜在的致命过敏反应。
