Lemière Catherine, Malo Jean-Luc
Université de Montréal, Service de pneumologie et Axe de recherche en santé respiratoire, Hôpital du Sacré-Coeur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec, H4J 1S9 Canada.
Med Sci (Paris). 2006 Jun-Jul;22(6-7):595-600. doi: 10.1051/medsci/20062267595.
The diagnosis of occupational asthma relies mainly on the demonstration of changes in airway calibre and airway responsiveness after exposure to occupational agents in the laboratory or at the workplace. However, spirometry or peak expiratory flow measurements may be open to misinterpretation when they are not performed optimally. As in non-occupational asthma, airway inflammation is one of the main characteristics of occupational asthma. Induced sputum, a non invasive method to assess airway inflammation, has been successfully used in the management of asthma. This article reviews the studies that have investigated and characterized the changes in sputum cell counts occurring in subjects with occupational asthma after exposure to occupational agents in the laboratory or at the workplace in order to assess the place of induced sputum in the investigation of occupational asthma. It also reviews the use of induced sputum during the follow-up of workers with occupational asthma after removal from exposure. This article also describes a new condition identified thanks to the use of induced sputum : occupational eosinophilic bronchitis. In conclusion, induced sputum is a useful tool in the investigation of occupational asthma. Its use on a regular basis in the investigation of occupational asthma also allows for the possibility of diagnosis of overlooked conditions such as occupational eosinophilic bronchitis. Its role in the surveillance of workers at risk to develop occupational asthma remains to be determined.
职业性哮喘的诊断主要依赖于在实验室或工作场所接触职业性致病因素后气道管径和气道反应性变化的证明。然而，当肺活量测定或呼气峰值流量测量未以最佳方式进行时，可能会被误解。与非职业性哮喘一样，气道炎症是职业性哮喘的主要特征之一。诱导痰作为一种评估气道炎症的非侵入性方法，已成功应用于哮喘的管理。本文回顾了一些研究，这些研究调查并描述了职业性哮喘患者在实验室或工作场所接触职业性致病因素后痰细胞计数的变化，以评估诱导痰在职业性哮喘调查中的地位。本文还回顾了诱导痰在职业性哮喘患者脱离接触后的随访中的应用。本文还描述了由于使用诱导痰而发现的一种新病症：职业性嗜酸性粒细胞性支气管炎。总之，诱导痰是职业性哮喘调查中的一种有用工具。在职业性哮喘调查中定期使用诱导痰，也有助于诊断被忽视的病症，如职业性嗜酸性粒细胞性支气管炎。其在监测有发生职业性哮喘风险的工人中的作用仍有待确定。
