哮喘联盟

   摘要
   背景:职业性哮喘 (OA) 的诊断具有挑战性并需要一个循序渐进的步骤。然而，在OA诊断中，乙酰甲胆碱激发试验的预测价值仍未确定。
   目的:我们试图评估在OA中乙酰甲胆碱激发试验的敏感性、特异性和阳性、阴性预测值。
   方法:我们使用了一个加拿大数据库，回顾了1983年到2011年的1012例病例，对象是疑似患有职业性哮喘并且做过特异性支气管激发试验的工人。我们计算了在吸入特异性激发物的基线水平，在和不在工作场所情形下，乙酰胆碱激发试验的敏感性、特异性和阴性及阳性预测值。
   结果:在基线水平, 乙酰胆碱激发试验整体的敏感性为80.2%，特异性为47.1%, 阳性及阴性预测值分别为36.5%和86.3%。在430例在职者中，基线测试显示的敏感性为95.4%, 特异性为40.1%, 阳性及阴性预测值分别为41.1%和95.2%。582 例受测者在工作场所外检测中,基线测试显敏感性和特异性为 66.7%和52%，阳性及阴性预测值分别为 31.9%和82.2%。对于在工作期间至少做过一次乙酰胆碱激发试验的受试者(479), 其敏感性和特异性,以及阳性及阴性预测值分别为98.1%、39.1%以及44.0%和97.7%。
   结论:对于仍暴露于工作中致病因素的患者来说，乙酰胆碱激发试验阴性者被诊断为职业性哮喘的可能性非常小。
 

（杨冬 审校）
JAllergyClinImmunol. 2015Jul25.pii:S0091-6749(15)00879-9.doi:10.1016/j.jaci.2015.06.026. [Epub ahead of print]

 

Predictive value of nonspecific bronchial responsiveness in occupational asthma.
 

Pralong JA1, Lemière C2, Rochat T3, L'Archevêque J2, Labrecque M2, Cartier A2.
 

Abstract
BACKGROUND:The diagnosis of occupational asthma (OA) can be challenging and needs a stepwise approach. However, the predictive value of the methacholine challenge has never been addressed specifically in this context.
OBJECTIVE:We sought to evaluate the sensitivity, specificity, and positive and negative predictive values of the methacholine challenge in OA.
METHODS:A Canadian database was used to review 1012 cases of workers referred for a suspicion of OA between 1983 and 2011 and having had a specific inhalation challenge. We calculated the sensitivity, specificity, and positive and negative predictive values of methacholine challenges at baseline of the specific inhalation challenge, at the workplace, and outside work.
RESULTS:At baseline, the methacholine challenge showed an overall sensitivity of 80.2% and a specificity of 47.1%, with positive and negative predictive values of 36.5% and 86.3%, respectively. Among the 430 subjects who were still working, the baseline measures displayed a sensitivity of 95.4%, a specificity of 40.1%, and positive and negative predictive values of 41.1% and 95.2%, respectively. Among the 582 subjects tested outside work, the baseline measures demonstrated a sensitivity and specificity of 66.7% and 52%, respectively, and positive and negative predictive values of 31.9% and 82.2%, respectively. When considering all subjects tested by a methacholine challenge at least once while at work (479), the sensitivity, specificity, and positive and negative predictive values were 98.1%, 39.1%, and 44.0% and 97.7%, respectively.
CONCLUSION:A negative methacholine challenge in a patient still exposed to the causative agent at work makes the diagnosis of OA very unlikely.
 

JAllergyClinImmunol. 2015Jul25.pii:S0091-6749(15)00879-9.doi:10.1016/j.jaci.2015.06.026. [Epub ahead of print]