Tarlo S M, Boulet L P, Cartier A, Cockcroft D, Côtè J, Hargreave F E, Holness L, Liss G, Malo J L, Chan-Yeung M
University of Toronto, Toronto, Canada.
Can Respir J. 1998 Jul-Aug;5(4):289-300. doi: 10.1155/1998/587580.
To provide broad guidelines and principles to help primary care physicians, occupational physicians, allergists and respirologists with the recognition, diagnosis and management of patients with occupational asthma (OA).
These guidelines are mainly directed towards OA induced by a workplace sensitizing agent. However, irritant-induced asthma and workplace aggravation of underlying asthma are also addressed, and some consideration is given to other differential diagnoses.
To enable the assessing physician to investigate patients with possible OA appropriately and to provide guidelines for appropriate early referral when specialized investigations are required. To provide an understanding of the appropriate management strategies following objective diagnosis.
The key diagnostic and management recommendations were based on a critical review of the literature and by specialist consensus meetings.
Evidence was categorized as follows. Level 1: Evidence from at least one randomized, controlled trial. Level 2: Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytical studies, preferably from more than one centre, from multiple time series or from dramatic results in uncontrolled experiments. Level 3: Evidence from the opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees. Evidence was further subdivided as follows: A. Good evidence to support a recommendation for use; B. Moderate evidence to support a recommendation for use; C. Poor evidence to support a recommendation for or against use; D. Moderate evidence to support a recommendation against use; E. Good evidence to support a recommendation against use.
BENEFITS, HARM AND COSTS: The medical and socioeconomic risks and benefits of an incorrect diagnosis of OA and of failure to diagnose true OA were considered in the recommendations.
The document has been reviewed and endorsed by the Canadian Thoracic Society, the Canadian Society of Allergy and Clinical Immunology, and The College of Family Physicians of Canada.
There is good evidence for rapid investigation and objective categorization of presented symptoms into OA, aggravation of underlying asthma, unrelated asthma or other diagnoses. OA should be suspected in all adult onset asthmatics whose asthma begins or worsens while they are working. Investigations should be directed to an objective assessment of asthma and then to an assessment of the work relationship, using a combination of investigations as feasible, which may include immunological tests, pulmonary function assessed during work periods and away from work, and specific challenge tests. Early specialist referral is recommended for diagnosis. Management strategies include general asthma management in addition to measures to avoid further exposure to a relevant workplace sensitizer. Compensation issues and other workers at risk of developing OA also need to be considered when the diagnosis is made.
提供广泛的指导方针和原则，以帮助初级保健医生、职业医生、过敏症专科医生和呼吸科医生识别、诊断和管理职业性哮喘（OA）患者。
这些指南主要针对由工作场所致敏剂引起的OA。然而，也涉及刺激性诱发的哮喘和工作场所对潜在哮喘的加重情况，并对其他鉴别诊断进行了一些考虑。
使评估医生能够对可能患有OA的患者进行适当的调查，并在需要进行专门检查时提供适当的早期转诊指南。在客观诊断后，提供对适当管理策略的理解。
关键的诊断和管理建议基于对文献的严格审查以及专家共识会议。
证据分为以下几类。1级：至少一项随机对照试验的证据。2级：至少一项设计良好但未随机分组的临床试验、队列研究或病例对照分析研究的证据，最好来自多个中心、多个时间序列或非对照实验中的显著结果。3级：基于临床经验、描述性研究或专家委员会报告的权威意见。证据进一步细分为：A. 有充分证据支持使用建议；B. 有中等证据支持使用建议；C. 证据不足，无法支持使用或不使用建议；D. 有中等证据支持不使用建议；E. 有充分证据支持不使用建议。
益处、危害和成本：在建议中考虑了OA诊断错误和未能诊断出真正OA的医学和社会经济风险及益处。
该文件已得到加拿大胸科学会、加拿大过敏与临床免疫学会以及加拿大家庭医生学院的审查和认可。
有充分证据支持对所呈现的症状进行快速调查，并将其客观分类为OA、潜在哮喘加重、无关哮喘或其他诊断。所有成年期发病且在工作时哮喘开始或加重的哮喘患者均应怀疑患有OA。调查应针对哮喘的客观评估，然后针对工作关系进行评估，可行时结合多种调查方法，可能包括免疫测试、工作期间和非工作期间的肺功能评估以及特异性激发试验。建议早期转诊至专科医生进行诊断。管理策略包括一般哮喘管理以及避免进一步接触相关工作场所致敏剂的措施。诊断时还需考虑赔偿问题以及其他有患OA风险的工人。
