Milton D K, Solomon G M, Rosiello R A, Herrick R F
Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
Am J Ind Med. 1998 Jan;33(1):1-10. doi: 10.1002/(sici)1097-0274(199801)33:1<1::aid-ajim1>3.0.co;2-2.
Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma.
职业性哮喘可能在成年期发病的哮喘中占相当大的比例，但根据医生报告监测和工伤赔偿数据得出的发病率估计值（0.9至15/100,000）低于基于社区的哮喘患者横断面研究的预期值。我们对79,204名年龄在15至55岁之间有哮喘风险的健康维护组织成员进行了一项前瞻性队列研究。使用计算机文件、病历和电话访谈来识别哮喘病例并对其进行特征描述。根据与工作相关的症状和工作场所暴露情况来确定职业暴露导致哮喘的证据。临床上显著的新发哮喘的年发病率为1.3/1,000，若将先前静止的哮喘复发病例包括在内，则发病率增至3.7/1,000。21%（95%可信区间12 - 32%）的病例符合职业暴露导致临床上显著哮喘发病的标准，发病率为71/100,000（95%可信区间43 - 111）。医生在15%的病历中记录了询问与工作相关的症状，在3例病例中记录了提示性症状，但均未进行职业医学咨询、诊断职业性哮喘、向州监测项目报告或为其中任何一例申请工伤赔偿。这些数据表明，职业暴露导致的哮喘发病率显著高于先前报告的水平，且在成年期发病的哮喘中占相当大的比例。
