Department of Chest Medicine, Mont-Godinne Hospital; Université Catholique de Louvain, B-5530 Yvoir, Belgium.
Respir Med. 2010 Apr;104(4):497-503. doi: 10.1016/j.rmed.2009.11.005. Epub 2009 Nov 28.
This study aimed at characterizing the nature, severity, and timing of nasal and ocular symptoms in subjects with work-exacerbated asthma (WEA).
Among the 363 subjects referred to a tertiary-care hospital for the investigation of work-related asthma symptoms, 105 subjects who demonstrated non-specific bronchial hyperresponsiveness to histamine, but a negative response to a specific inhalation challenge with the suspected occupational agent(s) were considered as having WEA. Their characteristics were compared with those of 172 subjects with occupational asthma (OA), ascertained by a positive response to a specific inhalation challenge.
A high proportion of subjects with WEA (83%) and OA (90%) reported at least one nasal symptom at work. Sneezing/itching and rhinorrhea were more frequent in subjects with OA (78% and 70%, respectively) than in those with WEA (61%, p = 0.004 and 57%, p = 0.038, respectively), while post-nasal discharge was more common in WEA (30%) than in OA (18%, p = 0.019). Nasal symptoms were less severe in WEA (median [25th-75th percentiles] global severity score: 4 [2-6]) as compared to OA (5 [4-7], p < 0.001). Nasal symptoms preceded less frequently those of asthma in subjects with WEA (17%) than in subjects with OA (43%, p = 0.001).
Nasal symptoms are highly prevalent in subjects with WEA, although their clinical pattern differs from that found in OA. Further investigations of the health and socio-economic impacts of upper airways symptoms in WEA are required to improve the understanding and management of this common condition.
本研究旨在描述工作加重型哮喘（WEA）患者鼻部和眼部症状的性质、严重程度和发生时间。
在因工作相关哮喘症状而被转诊至三级保健医院的 363 名患者中，105 名对组胺呈非特异性支气管高反应性，但对可疑职业性变应原的特异性吸入激发试验呈阴性反应的患者被认为患有 WEA。将这些患者的特征与 172 名对特异性吸入激发试验呈阳性反应的职业性哮喘（OA）患者的特征进行比较。
WEA（83%）和 OA（90%）患者中有很大比例报告在工作时至少有一种鼻部症状。打喷嚏/瘙痒和流涕在 OA 患者（分别为 78%和 70%）中比 WEA 患者（分别为 61%，p=0.004 和 57%，p=0.038）更常见，而在 WEA 患者（30%）中比在 OA 患者（18%）中更常见后鼻分泌物（p=0.019）。与 OA 患者（5 [4-7]）相比，WEA 患者的鼻部症状严重程度较轻（中位数[25-75 百分位数]总体严重程度评分：4 [2-6]，p<0.001）。与 OA 患者（43%，p=0.001）相比，WEA 患者鼻部症状更不常先于哮喘症状发生（17%）。
鼻部症状在 WEA 患者中高度普遍，但与 OA 患者中发现的症状模式不同。需要进一步研究 WEA 患者上呼吸道症状对健康和社会经济的影响，以改善对这种常见疾病的理解和管理。
