LaKind Judy S, Goodman Michael
LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, MD 21228 USA.
2University of Maryland School of Medicine, Baltimore, MD USA.
Allergy Asthma Clin Immunol. 2019 Nov 21;15:69. doi: 10.1186/s13223-019-0384-8. eCollection 2019.
In this paper, we review methodological approaches used in studies that evaluated the association between occupational exposure to quaternary ammonium compounds (quats) and occupational asthma. This association is of interest because quats are a common active ingredient of disinfectants and have been linked to work-related asthma in some circumstances. However, any evidence-based assessment of an exposure-outcome association needs to consider both strengths and limitations of the literature. We focus on publications cited by various US and international organizations. Eighteen investigations included in the review fall into two broad categories: case reports and challenge studies of individual patients and population studies that examined the association between quats and asthma occurrence in groups of subjects. We evaluated these studies guided by questions that address whether: exposure data on specific quat(s) and other agents that may cause asthma were included, new asthma cases were differentiated from asthma exacerbation, and information on respiratory sensitivity versus irritation was given. We also assessed consistency across studies. Studies of individual patients, particularly those that provided detailed information on challenge test results, document cases of asthma induced by exposure to quats. By contrast, studies of occupational groups with the highest potential for quats exposure (e.g., cleaners and farmers) do not consistently report increased incidence of asthma due specifically to quats. The unresolved methodological issues include: poor understanding of exposure pathways considering that quats are non-volatile, lack of quantitative data allowing for identification of an asthmagenicity threshold, insufficient information on whether quats are sensitizers or act via dose-dependent irritation or some other mechanism, and inability to quantify risk of new-onset asthma attributable to quats. Another important area of uncertainty is the lack of information on the specific quats being used. There is also a lack of data capable of distinguishing the effects of quats from those of other chemical and biological workplace exposures. The current state-of-the-science does not allow a proper assessment of the potential link between quats and occupational asthma.
在本文中，我们回顾了评估职业性接触季铵化合物（季铵盐）与职业性哮喘之间关联的研究中所使用的方法学途径。这种关联备受关注，因为季铵盐是消毒剂的常见活性成分，并且在某些情况下与职业性哮喘有关。然而，对暴露-结果关联进行任何基于证据的评估都需要考虑文献的优势和局限性。我们重点关注美国和国际各组织引用的出版物。纳入该综述的18项调查分为两大类：个体患者的病例报告和激发试验研究，以及在受试者群体中检查季铵盐与哮喘发生之间关联的人群研究。我们依据以下问题对这些研究进行评估：是否纳入了特定季铵盐和其他可能导致哮喘的物质的暴露数据，新哮喘病例是否与哮喘加重相区分，以及是否给出了关于呼吸道敏感性与刺激性的信息。我们还评估了各项研究之间的一致性。个体患者的研究，尤其是那些提供了激发试验结果详细信息的研究，记录了因接触季铵盐而诱发哮喘的病例。相比之下，季铵盐暴露可能性最高的职业群体（如清洁工和农民）的研究并未一致报告因季铵盐导致的哮喘发病率增加。尚未解决的方法学问题包括：鉴于季铵盐不挥发，对暴露途径了解不足；缺乏定量数据以确定致喘阈值；关于季铵盐是致敏剂还是通过剂量依赖性刺激或其他某种机制起作用的信息不足；以及无法量化因季铵盐导致的新发哮喘风险。另一个重要的不确定领域是缺乏关于所使用的特定季铵盐的信息。也缺乏能够区分季铵盐的影响与其他化学和生物工作场所暴露影响的数据。当前的科学现状不允许对季铵盐与职业性哮喘之间的潜在联系进行恰当评估。
