Moscato G, Perfetti L, Galdi E
Medical Center of Pavia, Dept of Allergy and Clinical Immunology, Specialization School of Allergology and Clinical Immunology, University of Pavia, Italy.
Monaldi Arch Chest Dis. 1997 Oct;52(5):469-73.
In this paper, the procedures in the assessment of occupational asthma (OA) are discussed. Only the most common subtype of OA is considered here, i.e. that in which symptoms appear after a latency period from the beginning of exposure. OA is characterized by variable bronchial obstruction, and variable bronchial hyperresponsiveness caused by specific agents inhaled at work. The clinical investigation of OA is a stepwise approach which includes a comprehensive history together with physiological and immunological studies. The first step is to identify symptoms and relate exposure at work to the presence in the workplace of substances known to provoke OA. The presence of bronchial asthma must then be confirmed; this is achieved by assessing the reversibility of bronchial obstruction and/or the presence of nonspecific bronchial hyperreactivity and/or the presence of significant peak expiratory flow (PEF) variability. The relationship between work and symptoms may first be assessed by means of serial measurements of PEF and of nonspecific bronchial hyperreactivity during periods at work and away from work. When the suspected agent is a high-molecular-weight (HMW) or a low-molecular-weight (LMW) agent known to act through an immunoglobulin E (IgE)-mediated mechanism, skin tests and/or research for specific IgE should be performed. In case of sensitization, where a relationship between asthma and work has been demonstrated by means of serial monitoring of PEF, a diagnosis can be made. If the suspected agent is a LMW agent, a specific inhalation challenge test in the laboratory or at the workplace is necessary.
本文讨论了职业性哮喘（OA）的评估程序。这里仅考虑OA最常见的亚型，即从接触开始经过一段潜伏期后出现症状的那种亚型。OA的特征是可变的支气管阻塞以及由工作中吸入的特定物质引起的可变支气管高反应性。OA的临床调查是一种逐步进行的方法，包括全面的病史以及生理和免疫学研究。第一步是识别症状，并将工作中的接触与工作场所中已知可引发OA的物质的存在联系起来。然后必须确认支气管哮喘的存在；这通过评估支气管阻塞的可逆性和/或非特异性支气管高反应性的存在和/或显著的呼气峰值流速（PEF）变异性来实现。工作与症状之间的关系可以首先通过在工作期间和非工作期间对PEF和非特异性支气管高反应性进行系列测量来评估。当疑似致病因子是已知通过免疫球蛋白E（IgE）介导机制起作用的高分子量（HMW）或低分子量（LMW）因子时，应进行皮肤试验和/或检测特异性IgE。在已通过PEF系列监测证明哮喘与工作之间存在关联的致敏情况下，可以做出诊断。如果疑似致病因子是LMW因子，则需要在实验室或工作场所进行特定的吸入激发试验。
