Gassert T H, Hu H, Kelsey K T, Christiani D C
Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA.
J Occup Environ Med. 1998 May;40(5):481-91. doi: 10.1097/00043764-199805000-00011.
Occupational asthma is common, yet little is known about long-term outcomes in the United States. A case series of 55 (of 72) occupational asthma patients were interviewed in follow-up 31 (+/- 15) months after removal from the cause to evaluate asthma severity and employment outcomes. Standard criteria were used to rate severity. At follow-up, 54 subjects (98%) had active asthma, of which 26 cases (47%) were "severe." Multivariate analysis showed increased risk of "severe" asthma for women (odds ratio [OR] = 13.8; 95% confidence interval [95% CI] = 1.3 to 151.7) and industrial sector workers (OR = 11.9; 95% CI = 1.3 to 109.8). Thirty-eight subjects (69%) were unemployed, risk being greater for those with "severe" asthma (OR = 20.9; 95% CI = 1.9 to 229.8) and for those without a college degree (OR = 7.3; 95% CI = 1.2 to 43.4). These results indicate that occupational asthma is disabling and probably irreversible for most patients referred to a specialty clinic, despite prolonged removal from causative agents. Women, industrial workers, and those with severe asthma or lack of a college degree appear to be at risk for worse outcomes. Greater efforts at primary and secondary prevention should lessen the burden of long-term illness and unemployment due to occupational asthma.
职业性哮喘很常见，但在美国对于其长期预后却知之甚少。对72例职业性哮喘患者中的55例进行了病例系列研究，在其脱离致病因素31（±15）个月后进行随访，以评估哮喘严重程度和就业情况。使用标准标准对严重程度进行分级。随访时，54名受试者（98%）患有活动性哮喘，其中26例（47%）为“重度”。多因素分析显示，女性（优势比[OR]=13.8；95%置信区间[95%CI]=1.3至151.7）和工业部门工人（OR=11.9；95%CI=1.3至109.8）发生“重度”哮喘的风险增加。38名受试者（69%）失业，“重度”哮喘患者（OR=20.9；95%CI=1.9至229.8）和未获得大学学位的患者（OR=7.3；95%CI=1.2至43.4）失业风险更大。这些结果表明，对于大多数转诊至专科诊所的患者而言，尽管已长期脱离致病因素，但职业性哮喘仍会导致残疾且可能不可逆转。女性、产业工人以及患有重度哮喘或未获得大学学位的人似乎预后更差。在一级和二级预防方面加大力度应可减轻职业性哮喘所致长期疾病和失业的负担。
