Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
BMJ Open. 2013 Sep 19;3(9):e003568. doi: 10.1136/bmjopen-2013-003568.
To determine the agents causing asthmatic reactions during specific inhalation challenges (SICs) in workers with cleaning-related asthma symptoms and to assess the pattern of bronchial responses in order to identify the mechanisms involved in cleaning-related asthma.
A retrospective case series analysis.
The study included all participants who completed an SIC procedure with the cleaning/disinfection products suspected of causing work-related asthma over the period 1992-2011 in a tertiary centre, which is the single specialised centre of the French-speaking part of Belgium where all participants with work-related asthma are referred to for SIC.
The review identified 44 participants who completed an SIC with cleaning/disinfection agents. Challenge exposure to the suspected cleaning agents elicited a ≥20% fall in forced expiratory volume in 1 s (FEV1) in 17 (39%) participants. The cleaning products that induced a positive SIC contained quaternary ammonium compounds (n=10), glutaraldehyde (n=3), both of these agents (n=1) and ethanolamines (n=2). Positive SICs were associated with a significant decrease in the median (IQR) value of the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) from 1.4 (0.2-4.2) mg/mL at baseline to 0.5 (0.4-3.0) mg/mL after the challenge and a significant increase in sputum eosinophils from 1.8 (0.8-7.2)% at baseline to 10.0 (4.1-15.9)% 7 h after the challenge exposure while these parameters did not significantly change in participants with a negative SIC. Overall, 11 of 17 participants with positive SICs showed greater than threefold decrease in postchallenge histamine PC20 value, a >2% increase in sputum eosinophils, or both of these outcomes.
These data indicate that a substantial proportion of workers who experience asthma symptoms related to cleaning materials show a pattern of bronchial reaction consistent with sensitiser-induced occupational asthma. The results also suggest that quaternary ammonium compounds are the principal cause of sensitiser-induced occupational asthma among cleaners.
确定在具有与清洁相关的哮喘症状的工人中进行特定吸入挑战（SIC）时引起哮喘反应的原因，并评估支气管反应模式，以确定与清洁相关的哮喘中涉及的机制。
回顾性病例系列分析。
该研究包括在 1992 年至 2011 年期间，在一家三级中心完成了与怀疑引起职业性哮喘的清洁/消毒剂相关的 SIC 程序的所有参与者，该中心是比利时法语区的唯一专门中心，所有与职业性哮喘相关的参与者都被转介到该中心进行 SIC。
审查确定了 44 名参与者完成了与清洁/消毒剂的 SIC。在 17 名（39%）参与者中，接触可疑清洁剂引起了用力呼气量在 1 秒内（FEV1）下降≥20%。引起阳性 SIC 的清洁产品含有季铵化合物（n=10）、戊二醛（n=3）、这两种物质（n=1）和乙醇胺（n=2）。阳性 SIC 与组胺引起 FEV1 下降 20%的激发浓度（PC20）中位数（IQR）值显著降低有关，从基线时的 1.4（0.2-4.2）mg/mL 降至挑战后 0.5（0.4-3.0）mg/mL，并且在挑战暴露后 7 小时痰液中嗜酸性粒细胞显著增加，从基线时的 1.8（0.8-7.2）%增加到 10.0（4.1-15.9）%，而在 SIC 阴性的参与者中，这些参数没有明显变化。总的来说，在 17 名阳性 SIC 参与者中，有 11 名的组胺 PC20 值在挑战后下降了三倍以上，痰嗜酸性粒细胞增加了 2%以上，或两者兼有。
这些数据表明，相当一部分出现与清洁材料相关的哮喘症状的工人表现出与致敏剂引起的职业性哮喘一致的支气管反应模式。结果还表明，季铵化合物是清洁剂引起的致敏剂职业性哮喘的主要原因。
