Dept of Chest Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium.
Occupational Medicine Team, Finnish Institute of Occupational Health, Helsinki, Finland H. Suojalehto and P. Cullinan are Task Force co-chairs
Eur Respir J. 2014 Jun;43(6):1573-87. doi: 10.1183/09031936.00180313. Epub 2014 Mar 6.
This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 s ≥ 15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.
本共识声明为职业性哮喘诊断中的特定吸入性挑战（SIC）提供了实用建议。这些建议源自系统文献检索、活跃的欧洲中心普查、德尔菲会议和专家共识。本文详细介绍了 SIC 的每一步骤，包括安全要求、药物输送技术，以及评估和解释支气管反应的方法。还讨论了该程序的局限性。测试只能在具有适当专业知识的医生和医疗保健专业人员的医院进行。测试应始终包括对照性挑战、逐渐增加对可疑药物的暴露，并在挑战期间和之后至少 6 小时密切监测患者。在专家中心，SIC 引起的过度反应很少见。阳性反应的定义是用力呼气量在 1 秒内下降≥基线的 15%。非特异性支气管反应性、痰嗜酸性粒细胞或呼出的一氧化氮的变化有时可以澄清不确定的反应。SIC 的敏感性和特异性都很高，但不容易量化，因为该方法通常用作职业性哮喘诊断的参考标准。
