Dalphin J C, Dubiez A, Monnet E, Gora D, Westeel V, Pernet D, Polio J C, Gibey R, Laplante J J, Depierre A
Departments of Respiratory Disease, Public Health, and Biochemistry, University Hospital of Besançon, Medical Department of the Mutualité Sociale Agricole of the Doubs, Besançon, France.
Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1493-8. doi: 10.1164/ajrccm.158.5.9709108.
With the aim of determining whether dairy farming is associated with an excess of asthma and respiratory symptoms, we compared the respiratory status in a sample of dairy farmers (n = 265) and a control group of nonexposed subjects (n = 149). The study protocol comprised a questionnaire, spirometry, and a bronchodilatation test (400 micrograms salbutamol powder), and an allergological evaluation: serum total IgE level, Phadiatop test, and skin prick tests (SPT) for seven inhalant allergens. Cumulative prevalences of self-reported asthma and of current asthma were respectively 5.3% and 1.5% in farmers, and respectively 3.4% and 1.3% in control subjects (both NS). Prevalences of all the respiratory symptoms studied were higher in farmers, with statistically significant differences after adjusting for age, sex, and smoking, for wheezing ever (OR: 2.7, p < 0.05), wheezing within the last year (OR: 5.2, p < 0.025), usual morning cough (OR: 5, p < 10(-)3), usual morning phlegm (OR: 11.3, p < 10(-)4), and chronic bronchitis (OR: 11.8, p < 0.01). The effect of exposure on these symptoms was more pronounced than, or of the same magnitude as that of smoking. Smoking and exposure had an additive effect except for chronic cough for which a positive interaction was observed (p = 0.05). Mean FEV1/VC (percentage of predicted) was statistically negatively correlated to dairy farming (p < 0.025) after adjusting for confounders. Bronchial obstruction was reversible in about 10% of subjects in both groups. In conclusion, this study mainly demonstrated an excess of respiratory symptoms in dairy farmers which is weak and nonsignificant for asthma, and high for cough, phlegm, and chronic bronchitis. It also suggested that the combined effect of farming and smoking was synergistic on chronic cough.
为了确定奶牛养殖是否与哮喘及呼吸道症状增多有关，我们比较了一组奶农（n = 265）和一组未接触奶牛养殖的对照组（n = 149）的呼吸状况。研究方案包括一份问卷、肺功能测定、支气管扩张试验（400微克沙丁胺醇粉末）以及过敏学评估：血清总IgE水平、Phadiatop试验和针对七种吸入性过敏原的皮肤点刺试验（SPT）。奶农中自我报告的哮喘和现患哮喘的累积患病率分别为5.3%和1.5%，对照组分别为3.4%和1.3%（均无统计学差异）。在对年龄、性别和吸烟进行校正后，奶农中所研究的所有呼吸道症状的患病率均较高，其中曾经喘息（比值比：2.7，p < 0.05）、过去一年喘息（比值比：5.2，p < 0.025）、通常早晨咳嗽（比值比：5，p < 10⁻³）、通常早晨咳痰（比值比：11.3，p < 10⁻⁴）以及慢性支气管炎（比值比：11.8，p < 0.01）的差异具有统计学意义。接触奶牛养殖对这些症状的影响比吸烟更显著或与之相当。吸烟和接触奶牛养殖具有相加作用，但慢性咳嗽存在正向交互作用（p = 0.05）。在校正混杂因素后，平均第一秒用力呼气容积/用力肺活量（预测值百分比）与奶牛养殖呈统计学负相关（p < 0.025）。两组中约10%的受试者支气管阻塞是可逆的。总之，本研究主要表明奶农存在过多的呼吸道症状，对哮喘而言症状轻微且无统计学意义，对咳嗽、咳痰和慢性支气管炎而言症状较为严重。研究还提示，奶牛养殖和吸烟对慢性咳嗽具有协同作用。
