Kremer A M, Pal T M, Boleij J S, Schouten J P, Rijcken B
University Groningen, Department of Epidemiology and Statistics, The Netherlands.
Am J Ind Med. 1994 Nov;26(5):655-69. doi: 10.1002/ajim.4700260508.
The association between exposure to airway irritants and the presence of work-related symptoms and whether this association was modified by airway hyper-responsiveness, smoking, and allergy by history was studied in 668 workers of synthetic fiber plants. A Dutch version of the British Medical Research Council (BMRC) questionnaire with additional questions on allergy and work-related symptoms was used to assess symptoms, and a standardized histamine challenge test of airway hyper-responsiveness (AHR) was employed. Work-related symptoms were defined as having more than usual eye and respiratory symptoms during work. On the basis of job titles and working department, the exposure status of all workers was characterized into seven groups: (1) reference group; (2) white collars; (3) SO2, HCl, SO4(2-); (4) polyester vapor; (5) oil mist and oil vapor; (6) polyamide and polyester vapor; and (7) multiple exposure. The association between exposure groups and work-related symptom prevalence was estimated by means of multiple logistic regression. The overall prevalence of the work-related symptoms were: cough 9%; phlegm 6%; dyspnea 7%; wheeze 2%; eye symptoms 16%; nasal symptoms 15%. Exposure to airway irritants was significantly associated with work-related symptoms, independent of AHR, smoking, allergy by history, and chronic respiratory symptoms. The association of exposure group with work-related symptoms was stronger for subjects with AHR than for subjects with no AHR. The association with dyspnea and/or wheeze was also stronger for smokers than for nonsmokers and ex-smokers. In contrast, the association between exposure and a higher prevalence of work-related symptoms was stronger in subjects with no history of allergy than in subjects with history of allergy. This is most likely due to the relatively high prevalence of background symptoms in (nonexposed) allergic subjects. It is concluded that exposure to irritants in the working environment might lead to respiratory symptoms, even if exposure levels are relatively low.
在668名合成纤维厂工人中，研究了接触气道刺激物与工作相关症状的存在之间的关联，以及这种关联是否会因气道高反应性、吸烟和既往过敏史而改变。使用一份荷兰版的英国医学研究委员会（BMRC）问卷，该问卷增加了有关过敏和工作相关症状的问题，以评估症状，并采用标准化的组胺气道高反应性（AHR）激发试验。工作相关症状定义为工作期间出现比平时更多的眼部和呼吸道症状。根据职位和工作部门，将所有工人的接触状况分为七组：（1）参照组；（2）白领；（3）二氧化硫、氯化氢、硫酸根；（4）聚酯蒸气；（5）油雾和油蒸气；（6）聚酰胺和聚酯蒸气；（7）多重接触。通过多因素logistic回归估计接触组与工作相关症状患病率之间的关联。工作相关症状的总体患病率为：咳嗽9%；咳痰6%；呼吸困难7%；喘息2%；眼部症状16%；鼻部症状15%。接触气道刺激物与工作相关症状显著相关，独立于气道高反应性、吸烟、既往过敏史和慢性呼吸道症状。与无气道高反应性的受试者相比，气道高反应性受试者的接触组与工作相关症状的关联更强。吸烟者与呼吸困难和/或喘息的关联也比非吸烟者和已戒烟者更强。相比之下，无过敏史的受试者中，接触与较高的工作相关症状患病率之间的关联比有过敏史的受试者更强。这很可能是由于（未接触）过敏受试者中背景症状的患病率相对较高。研究得出结论，即使接触水平相对较低，工作环境中接触刺激物也可能导致呼吸道症状。
