Occupational Lung Disease Service, Birmingham Heartlands Hospital, Birmingham, UK
Institute of Applied Heath Research, University of Birmingham, Birmingham, UK.
BMJ Open Respir Res. 2024 Sep 30;11(1):e001943. doi: 10.1136/bmjresp-2023-001943.
Work-related asthma accounts for ≥25% of asthma in working-age populations, though the relationship between work exposures and symptoms is frequently missed, leading to poor health and employment outcomes. We hypothesised that inhalable exposures at work are associated with poor asthma control in severe asthma (SA).
We searched the Birmingham (UK) Regional NHS SA Service clinical database (n=1453 records; 1 March 2004 to 1 March 2021) and undertook a cross-sectional study using baseline data collected at diagnosis. We included all employed patients aged 16-64 with documented current occupation (n=504), and collected socio-demographic, general health and asthma-specific data, including Asthma Control Questionnaire 7 (ACQ7) score. The Occupational Asthma Specific Job-Exposure Matrix (OAsJEM) was employed to determine the likelihood of exposure to respiratory sensitisers, irritants, cleaning agents and detergents; associations between exposures and ACQ7 were investigated using binary and multinomial regression.
Frequently reported occupations were care assistants (7%) and nurses (6%); 197/504 (39%) patients were exposed to an asthmagen, including respiratory sensitisers (30%), airway irritants (38%) and cleaning products/disinfectants (29%). ACQ7 score was available for 372/504 (74%) patients, of whom 14% had adequate control (ACQ7=0-1.5). After adjustment for major confounders there were no significant associations between inhaled asthmagens and ACQ7 score (either as binary or multinomial outcomes).
JEM-determined workplace exposures to inhaled asthmagens are not associated with asthma control in SA; 29-39% of patients may have current exposure to workplace asthmagens. Routine collection of lifetime occupational data including current job role and level of exposure, in the national asthma registry, would give further insights into this relationship.
与工作相关的哮喘占工作年龄段人群哮喘的≥25%，尽管工作暴露与症状之间的关系经常被忽视，导致健康状况和就业结果不佳。我们假设工作场所的可吸入暴露与严重哮喘（SA）的哮喘控制不佳有关。
我们搜索了伯明翰（英国）地区 NHS SA 服务临床数据库（n=1453 份记录；2004 年 3 月 1 日至 2021 年 3 月 1 日），并使用在诊断时收集的基线数据进行了横断面研究。我们纳入了所有有记录的当前职业的 16-64 岁在职患者（n=504），并收集了社会人口统计学、一般健康和哮喘特异性数据，包括哮喘控制问卷 7 分（ACQ7）评分。使用职业性哮喘特定工作暴露矩阵（OAsJEM）来确定接触呼吸道致敏剂、气道刺激物、清洁剂和洗涤剂的可能性；使用二项式和多项逻辑回归来研究暴露与 ACQ7 之间的关系。
报告的常见职业包括护理助理（7%）和护士（6%）；504 名患者中有 197 名（39%）接触到哮喘原，包括呼吸道致敏剂（30%）、气道刺激物（38%）和清洁产品/消毒剂（29%）。372/504 名（74%）患者可获得 ACQ7 评分，其中 14%的患者控制良好（ACQ7=0-1.5）。在调整了主要混杂因素后，吸入性哮喘原与 ACQ7 评分之间没有显著关联（无论是作为二项式还是多项逻辑回归结果）。
JEM 确定的工作场所吸入性哮喘原暴露与 SA 中的哮喘控制无关；29-39%的患者可能目前接触工作场所哮喘原。在国家哮喘登记处常规收集终生职业数据，包括当前工作角色和暴露水平，将进一步深入了解这种关系。
