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与有机粉尘暴露相关的呼吸道疾病。

Respiratory Diseases Associated With Organic Dust Exposure.

机构信息

Division of Allergy & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb.

Division of Allergy & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb.

出版信息

J Allergy Clin Immunol Pract. 2024 Aug;12(8):1960-1971. doi: 10.1016/j.jaip.2024.02.022. Epub 2024 Feb 27.

Abstract

Organic dusts are complex bioaerosol mixtures comprised of dust and par ticulate matter of organic origin. These include components from bacteria, fungi, pollen, and viruses to fragments of animals and plants commonplace to several environmental/occupational settings encompassing agriculture/farming, grain processing, waste/recycling, textile, cotton, woodworking, bird breeding, and more. Organic dust exposures are linked to development of chronic bronchitis, chronic obstructive pulmonary disease, asthma, asthma-like syndrome, byssinosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis. Risk factors of disease development include cumulative dust exposure, smoking, atopy, timing/duration, and nutritional factors. The immunopathogenesis predominantly involves Toll-like receptor signaling cascade, T-helper 1/T-helper 17 lymphocyte responses, neutrophil influx, and potentiation of manifestations associated with allergy. The true prevalence of airway disease directly attributed to organic dust, especially in a workplace setting, remains challenging. Diagnostic confirmation can be difficult and complicated by hesitancy from workers to seek medical care, driven by fears of potential labor-related consequence. Clinical respiratory and systemic presentations coupled with allergy testing, lung function patterns of obstructive versus restrictive disease, and radiological characteristics are typically utilized to delineate these various organic dust-associated respiratory diseases. Prevention, risk reduction, and management primarily focus on reducing exposure to the offending dust, managing symptoms, and preventing disease progression.

摘要

有机粉尘是由灰尘和有机来源的颗粒物组成的复杂生物气溶胶混合物。这些成分包括细菌、真菌、花粉和病毒的碎片,以及在农业/耕作、谷物加工、废物/回收、纺织、棉花、木材加工、鸟类养殖等多个环境/职业环境中常见的动植物碎片。有机粉尘暴露与慢性支气管炎、慢性阻塞性肺疾病、哮喘、类哮喘综合征、棉尘病、过敏性肺炎和特发性肺纤维化的发展有关。疾病发展的危险因素包括累积粉尘暴露、吸烟、特应性、时间/持续时间和营养因素。免疫发病机制主要涉及 Toll 样受体信号级联、T 辅助细胞 1/T 辅助细胞 17 淋巴细胞反应、中性粒细胞浸润以及过敏相关表现的增强。直接归因于有机粉尘的气道疾病的真实患病率,尤其是在工作场所,仍然具有挑战性。诊断确认可能很困难,并且由于工人担心潜在的与劳动相关的后果而不愿寻求医疗护理,这使得情况变得复杂。临床呼吸和全身表现,结合过敏测试、阻塞性与限制性疾病的肺功能模式以及影像学特征,通常用于描绘这些各种与有机粉尘相关的呼吸疾病。预防、降低风险和管理主要侧重于减少对致病粉尘的暴露、控制症状和预防疾病进展。

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