Talini D, Benvenuti A, Carrara M, Vaghetti E, Martin L Bianchi, Paggiaro P L
Cardio-Thoracic Department, Respiratory Pathophysiology, University of Pisa, Italy.
Respir Med. 2002 Apr;96(4):236-43. doi: 10.1053/rmed.2001.1259.
The diagnosis of occupational asthma is usually performed in epidemiology using a combination of symptoms and bronchial hyperresponsiveness, while in a clinical setting the 'gold standard' for the diagnosis of occupational asthma is the specific bronchial challenge test in the laboratory The aim of this study was to detect new cases of flour-induced occupational asthma (OA) in a group of workers exposed to grain and/or flour dust, by means of a step-by-step approach, as used in a clinical setting. In an epidemiological study, III millers and 186 bakers were examined by means of questionnaire, pulmonary function tests and skin-prick tests (SPT) to common allergens and to wheat flour dust extracts. From the whole sample, 82 subjects who showed asthma-like symptoms in the questionnaire and/or low forced expiratory volume in 1 sec (FEV1) were selected. Selected subjects underwent methacholine challenge test, and hyperreactive subjects underwent specific bronchial challenge with flour dust in the laboratory. Sixty-two of the selected subjects performed the methacholine challenge test, and 22 (33 8%) were hyperreactive (PD20 FEV1 <1 mg of methacholine). Fifteen of 22 hyperreactive subjects underwent specific bronchial challenge test (s BCT) with flour dust; a positive response was elicited in six subjects. These subjects can be diagnosed as having flour-induced occupational asthma. Atopy and skin sensitivity to flour was partially related to the response to flour bronchial challenge. Bronchial hyperreactivity can be observed in a small percentage of subjects with asthma-like symptoms and/or low FEV1, and a positive response to s BCTwas observed in a subgroup of hyperreactive subjects.Therefore, using these selection criteria, a diagnosis of flour-induced OA, as commonly performed in a clinical setting, can be performed in few previously undiagnosed subjects.This approach could be relevant for an early diagnosis ofoccupational asthma.
职业性哮喘的诊断在流行病学中通常结合症状和支气管高反应性进行，而在临床环境中，职业性哮喘诊断的“金标准”是实验室特定的支气管激发试验。本研究的目的是通过临床环境中使用的逐步方法，在一组接触谷物和/或面粉粉尘的工人中检测面粉诱发的职业性哮喘（OA）新病例。在一项流行病学研究中，通过问卷调查、肺功能测试以及针对常见变应原和小麦面粉粉尘提取物的皮肤点刺试验（SPT）对111名磨坊工人和186名面包师进行了检查。从整个样本中，选择了82名在问卷中表现出哮喘样症状和/或一秒用力呼气量（FEV1）较低的受试者。选定的受试者接受了乙酰甲胆碱激发试验，反应性过高的受试者在实验室接受了面粉粉尘特异性支气管激发试验。选定的受试者中有62名进行了乙酰甲胆碱激发试验，其中22名（33.8%）反应性过高（乙酰甲胆碱PD20 FEV1<1mg）。22名反应性过高的受试者中有15名接受了面粉粉尘特异性支气管激发试验（sBCT）；6名受试者出现阳性反应。这些受试者可被诊断为患有面粉诱发的职业性哮喘。特应性和对面粉的皮肤敏感性与对面粉支气管激发试验的反应部分相关。在一小部分有哮喘样症状和/或低FEV1的受试者中可观察到支气管高反应性，在反应性过高的受试者亚组中观察到对sBCT的阳性反应。因此，使用这些选择标准，可以在少数先前未确诊的受试者中进行临床环境中常见的面粉诱发OA的诊断。这种方法可能与职业性哮喘的早期诊断相关。
