Ann Am Thorac Soc. 2013 Aug;10(4):S17-24. doi: 10.1513/AnnalsATS.201305-119ST.
Work-related asthma is a common occupational lung disease. The scope of the Fourth Jack Pepys Workshop that was held in May 2010 went beyond asthma to include discussion of other occupational airway diseases, in particular occupationally related chronic obstructive pulmonary disease (COPD) and bronchiolitis. Aspects explored included public health considerations, environmental aspects, outcome after diagnosis, prevention and surveillance, and other work-related obstructive airway diseases. Consistent methods are needed to accurately estimate the comparative burden of occupation-related airway diseases among different countries. Challenges to accomplishing this include variability in health care delivery, compensation systems, cultural contexts, and social structures. These factors can affect disease estimates, while heterogeneity in occupations and workplace exposures can affect the underlying true prevalence of morbidity. Consideration of the working environment included discussion of practical methods of limiting exposure to respiratory sensitizers, methods to predict new sensitizers before introduction into workplaces, the role of legislated exposure limits, and models to estimate relative validity of various ameliorative measures when complete avoidance of the sensitizer is not feasible. Other strategies discussed included medical surveillance measures and education, especially for young individuals with asthma and new workers about to enter the workforce. Medical outcomes after development of sensitizer-induced occupational asthma are best following earlier diagnosis and removal from further exposure, but a subset may be able to continue working safely provided that exposure is reduced under close follow-up monitoring. It was recognized that occupationally related COPD is common but underappreciated, deserving further study and prevention efforts.
职业性哮喘是一种常见的职业性肺部疾病。2010 年 5 月举行的第四届杰克·佩皮斯研讨会的范围超出了哮喘，包括讨论其他职业性气道疾病，特别是与职业有关的慢性阻塞性肺疾病（COPD）和细支气管炎。探讨的方面包括公共卫生方面、环境方面、诊断后的结果、预防和监测以及其他与职业有关的阻塞性气道疾病。需要采用一致的方法来准确估计不同国家职业性气道疾病的相对负担。实现这一目标的挑战包括医疗保健提供、赔偿制度、文化背景和社会结构的差异。这些因素会影响疾病估计，而职业和工作场所暴露的异质性会影响发病率的真实流行率。对工作环境的考虑包括讨论限制接触呼吸道致敏剂的实用方法、在将新致敏剂引入工作场所之前预测新致敏剂的方法、法定暴露限度的作用以及在无法完全避免致敏剂的情况下估计各种改善措施的相对有效性的模型。讨论的其他策略包括医疗监测措施和教育，特别是对患有哮喘的年轻人和即将进入劳动力市场的新工人。在发生致敏剂诱发的职业性哮喘后，最好在早期诊断和避免进一步暴露后进行医疗结局评估，但如果在密切随访监测下减少暴露，一部分人可能能够安全继续工作。人们认识到，与职业有关的 COPD 很常见，但未被充分认识，值得进一步研究和预防努力。
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