Department of Occupational Diseases and Toxicology, Nofer Institute of Occupational Medicine, Łódź, Poland.
Int J Occup Med Environ Health. 2012 Jun;25(3):242-50. doi: 10.2478/S13382-012-0031-9. Epub 2012 Jun 22.
The aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders.
Examination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed.
In group A--in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B--only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders.
Specific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders.
本研究旨在评估波兰焊工金属性哮喘中并存因素及诊断方法的有效性。
对 50 名职业性接触金属且疑似金属性哮喘的焊工（A 组）、100 名职业性接触金属但无金属性哮喘疑似症状的焊工（B 组）以及两组对照组（10 例特应性哮喘患者和 10 例健康受试者）进行了检查。采用问卷调查、临床检查、常见气传变应原和金属盐的皮肤点刺试验、基础肺功能测试、X 射线检查、乙酰甲胆碱激发试验以及金属（或类似工作条件）的单盲、安慰剂对照特异性吸入激发试验进行评估。
在 A 组中，我们在 9 例患者中获得了金属特异性吸入激发试验的阳性结果（3 例为镍，4 例为铬，1 例为钴，1 例为锰）。共确诊 9 例金属性职业性哮喘。在 B 组中，仅有 1 例患者获得类似工作条件激发试验的阳性结果（临床和肺功能改变，诱导痰中嗜酸性粒细胞增多），证实了职业性哮喘的诊断。在大多数接受检查的焊工中（62%），胸部 X 射线图像显示肺部有变化。统计分析表明，焊接工作超过 10 年是出现胸部 X 射线改变（p 型或 q 型结节状改变或间质性改变）的共存因素。金属盐皮肤点刺试验阳性是焊工金属性哮喘的共存因素。
特异性吸入激发试验在焊工金属性哮喘的诊断中起着关键作用。在接受检查的焊工中，有相当比例的人胸部 X 射线显示肺部有变化。
