Dykewicz Mark S
Allergy and Immunology Service, Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Allergy Clin Immunol. 2009 Mar;123(3):519-28; quiz 529-30. doi: 10.1016/j.jaci.2009.01.061.
Occupational asthma (OA) may account for 25% or more of de novo adult asthma. The nomenclature has now better defined categories of OA caused by sensitizing agents and irritants, the latter best typified by the reactive airways dysfunction syndrome. Selecting the most appropriate diagnostic testing and management is driven by assessing whether a sensitizer is involved, and if so, identifying whether the sensitizing agent is a high-molecular-weight agent such as a protein or a low-molecular-weight reactive chemical such as an isocyanate. Increased understanding of the pathogenesis of OA from reactive chemical sensitizers is leading to development of better diagnostic testing and also an understanding of why testing for sensitization to such agents can be problematic. Risk factors for OA including possible genetic factors are being delineated better. Recently published guidelines for the diagnosis and management of occupational asthma are summarized; these reflect an increasingly robust evidence basis for recommendations. The utility of diagnostic tests for OA is being better defined by evidence, including sputum analysis performed in relation to work exposure with suspected sensitizers. Preventive and management approaches are reviewed. Longitudinal studies of patients with OA continue to show that timely removal from exposure leads to the best prognosis.
职业性哮喘（OA）可能占成年新发哮喘病例的25%或更多。目前，该命名法已更好地定义了由致敏剂和刺激物引起的OA类别，后者以反应性气道功能障碍综合征最为典型。选择最合适的诊断测试和管理方法，取决于评估是否涉及致敏剂，如果涉及，则要确定致敏剂是高分子量物质（如蛋白质）还是低分子量反应性化学物质（如异氰酸酯）。对由反应性化学致敏剂引起的OA发病机制的深入了解，正促使人们开发出更好的诊断测试方法，同时也有助于理解为何针对此类物质的致敏检测可能存在问题。包括可能的遗传因素在内的OA危险因素正得到更清晰的界定。本文总结了最近发布的职业性哮喘诊断和管理指南；这些指南反映出其建议的证据基础日益坚实。证据正更好地界定OA诊断测试的效用，包括针对疑似致敏剂工作暴露进行的痰液分析。本文还对预防和管理方法进行了综述。对OA患者的纵向研究继续表明，及时脱离暴露可带来最佳预后。
