Lemière Catherine
Department of Chest Medicine, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada.
Curr Opin Allergy Clin Immunol. 2004 Apr;4(2):81-5. doi: 10.1097/00130832-200404000-00002.
The diagnosis of occupational asthma needs to be made objectively using as many criteria as possible. These include laboratory exposure tests with occupational agent(s), which are only available in specialized centres. Another approach is to monitor peak expiratory flow or methacholine airway responsiveness during periods at work and away from work. However, these measurements are open to misinterpretation when they are not performed optimally. Airway inflammation is one of the main characteristics of occupational asthma, but is not often assessed during its investigation. The purpose of this work was to review recent studies that have investigated and characterized the changes in sputum cell counts occurring in patients with occupational asthma, in order to evaluate the role of the analysis of sputum cell counts.
There is evidence that monitoring sputum eosinophils can help in the management of asthma. In the majority of cases of occupational asthma, the percentage of sputum eosinophils increases after exposure to occupational agents in the laboratory compared with baseline, but an increase in sputum neutrophils has also been observed. The changes in airway inflammation occurring at the workplace have been less investigated, but indicate that there are significant changes in airway inflammation and especially sputum eosinophils when workers are exposed to a sensitizer at their workplace compared with periods away from the workplace.
Induced sputum has successfully been used to manage patients with mild to moderate asthma. Its use is promising in occupational asthma, and its role in the investigation of occupational asthma needs to be better defined.
职业性哮喘的诊断需要尽可能多地使用客观标准。这些标准包括针对职业性致病因素的实验室暴露试验，而此类试验仅在专业中心开展。另一种方法是在工作期间和非工作期间监测呼气峰值流速或乙酰甲胆碱气道反应性。然而，如果这些测量未得到最佳实施，其结果可能会被误解。气道炎症是职业性哮喘的主要特征之一，但在其调查过程中并不常被评估。本文旨在综述近期有关研究职业性哮喘患者痰液细胞计数变化并对其特征进行描述的研究，以评估痰液细胞计数分析的作用。
有证据表明监测痰液嗜酸性粒细胞有助于哮喘的管理。在大多数职业性哮喘病例中，与基线相比，在实验室接触职业性致病因素后痰液嗜酸性粒细胞百分比会升高，但也观察到痰液中性粒细胞增加。对于工作场所发生的气道炎症变化研究较少，但研究表明，与非工作期间相比，当工人在工作场所接触致敏原时，气道炎症尤其是痰液嗜酸性粒细胞会发生显著变化。
诱导痰已成功用于轻至中度哮喘患者的管理。其在职业性哮喘中的应用前景良好，但其在职业性哮喘调查中的作用需要进一步明确。
