Gannon P F, Weir D C, Robertson A S, Burge P S
Occupational Lung Disease Unit, East Birmingham Hospital.
Br J Ind Med. 1993 Jun;50(6):491-6. doi: 10.1136/oem.50.6.491.
To study the health, employment, and financial outcome of occupational asthma.
A follow study of workers with confirmed occupational asthma.
A specialist occupational lung disease clinic.
All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology.
Respiratory symptoms, medication, pulmonary function, employment state, and financial position.
112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05).
Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis.
研究职业性哮喘患者的健康、就业及经济状况。
对确诊为职业性哮喘的工人进行随访研究。
一家专业职业性肺病诊所。
所有工人至少在一年前被诊断为职业性哮喘。诊断通过连续呼气峰值流速测量、特异性支气管激发试验或特异性免疫学检查得以证实。
呼吸道症状、药物治疗、肺功能、就业状况及经济状况。
140名符合条件的工人中有112名接受了随访。32%的患者仍暴露于致病因素。这些工人在随访时的症状比已脱离暴露的工人更多，且更多人正在使用吸入性类固醇药物。持续暴露还与一秒用力呼气容积（FEV1）预计值较初诊时下降3%有关。他们因职业性哮喘导致的年收入中位数损失为35%。已脱离暴露的工人经济状况更差（年收入中位数损失54%），呼吸道症状比仍暴露的工人少，且他们的FEV1预计值提高了4.6%。法定赔偿和通过普通法律诉讼获得的赔偿与因职业性哮喘发病导致的收入损失不相符。在已脱离暴露的工人中，那些不再抱怨呼吸困难的工人在首次出现症状后被诊断的时间明显更早（48个月对66个月，p = 0.001），且初诊时的FEV1明显更高（预计值为90%对73%，p = 0.008），与仍有呼吸困难的工人相比。他们在首次暴露后出现症状更早（48个月对66个月，p > 0.05），且脱离暴露的时间更早（8个月对12个月，p > 0.05）。
职业性哮喘诊断后脱离暴露在症状和肺功能方面有益，但与收入损失有关。早期诊断对于脱离暴露后症状的改善很重要。赔偿不足可能促使工人在诊断后仍选择继续暴露。
