Rüegger M
Abteilung Arbeitsmedizin, SUVA, Luzern.
Schweiz Rundsch Med Prax. 1991 Oct 1;80(40):1054-7.
The recognition of bronchial asthma as occupational disease is essentially a matter of legislation and not of medical definitions. Swiss law accepts an occupational nature of asthma when its causes derive to more than 50% from the work place. Causes are extremely diverse, whereby in Europe flour (bakers) and isocyanates (spray lacquers) dominate. Together, these causative agents contribute close to 50% of all cases of occupational asthma. The clinical picture is that of classic bronchial asthma. Peculiarities are seen only regarding the temporal dependence between exposition and beginning of airway obstruction. Regarding diagnosis of occupational asthma the following questions should be answered. 1. Is the dyspnea described by the patient real bronchial asthma? 2. Is there a documented temporal connection between exposition and complaints? 3. Is there a causative agent at the work place? Peak-flow measurements are particularly useful for documentation of connection of symptoms with occupation. They demand, however, a certain degree of cooperation by the patient. The prime therapeutic measure is avoidance of further contacts with the responsible agent. The Swiss health authorities (SUVA) have the power to issue decisions of unsuitability for certain workplaces or exposures. Such a measure is however severe and requires therefore a careful diagnosis and an evaluation of risk and benefit for the patient.
将支气管哮喘认定为职业病本质上是一个立法问题，而非医学定义问题。瑞士法律规定，如果哮喘病因50%以上源自工作场所，那么就认定其具有职业性。病因极为多样，在欧洲，面粉（面包师）和异氰酸酯（喷漆）是主要病因。这些致病因素加起来占所有职业性哮喘病例的近50%。临床表现为典型的支气管哮喘。特殊之处仅体现在接触与气道阻塞开始之间的时间相关性方面。关于职业性哮喘的诊断，应回答以下问题。1. 患者描述的呼吸困难是真正的支气管哮喘吗？2. 在接触与症状之间是否有记录在案的时间关联？3. 工作场所有致病因素吗？峰值流量测量对于记录症状与职业之间的关联特别有用。然而，这需要患者一定程度的配合。主要的治疗措施是避免进一步接触致病因素。瑞士卫生当局（SUVA）有权就某些工作场所或接触情况发布不适宜工作的决定。然而，这样的措施很严厉，因此需要进行仔细诊断，并对患者的风险和益处进行评估。
