Fishwick David, Forman Steve
Centre for Workplace Health, Science Division, Health and Safety Executive of Great Britain, Harpur Hill, Buxton, Derbyshire, UK.
Curr Opin Allergy Clin Immunol. 2018 Apr;18(2):80-86. doi: 10.1097/ACI.0000000000000424.
The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma.
The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance.
Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.
早期诊断的职业性哮喘患者预后较好。工作场所的健康监测原则上旨在识别此类病例，从而降低个体工人及其同事面临的风险。最近有证据表明，这种监测的接受程度和质量有待提高。本综述评估了职业性哮喘健康监测的当前方法。
本文回顾了问卷调查、肺功能测试、免疫调查及其他检测方法（包括呼出一氧化氮、痰液嗜酸性粒细胞增多及呼出气冷凝物）在基于工作场所的健康监测中的应用。
问卷调查仍是呼吸系统健康监测的关键组成部分，不过对早期职业性哮喘的敏感性和特异性可能有限。肺功能测试的作用存在争议，不过推荐用于更高级别的健康监测。文中讨论了健康监测中免疫检测的各种实例，但在许多特定领域，还需要更多证据才能给出更普遍的建议。文中还讨论了呼出一氧化氮、痰液嗜酸性粒细胞增多及呼出气冷凝物等新方法应用的相关证据。
