职业性哮喘和劳力加重性哮喘
2007/08/01
工作相关性哮喘（WRA）经常容易延误诊治，而影响患者首次就诊、疑似和确诊时间的因素目前尚不是很明确。为比较职业性哮喘组（OA组）和劳力加重性哮喘组（WEA组）患者在确诊前个体差异及工作等因素是否对疾病的延误有影响，Marlene S. Santos等对各100例的职业性肺病的临床疑似WRA患者和对照组进行问卷调查并汇总，筛选出80个受试者有致敏原诱发OA，87例有WEA。在OA组中，延误病情的因素有：男性、未婚、受教育程度低以及对出现的症状和工作环境间的关联缺乏警觉性。其它影响因素还包括高龄、收入来源单一、缺乏对工作环境有害物质等信息的认识。在WEA组中，低收入水平、低教育水平、工作中无健康安全保障、无工会保护、缺乏对OA以及工作中可特异性引发哮喘的一些事物的认识等因素，也使发病到确诊这段时间延长。
这项流调说明许多因素都可影响OA和WEA的确诊时间，延误病情。因此，对OA和WEA高危人群的教育就显得很必要，同时也需要进一步提高基层医师对WRA的认识。
这项流调说明许多因素都可影响OA和WEA的确诊时间，延误病情。因此，对OA和WEA高危人群的教育就显得很必要，同时也需要进一步提高基层医师对WRA的认识。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2007; 131:1768-1775)
Occupational Asthma and Work-Exacerbated Asthma*
Factors Associated With Time to Diagnostic Steps
Marlene S. Santos, MD; Hyejung Jung, MSc; Javad Peyrovi, MD; Wendy Lou, PhD; Gary M. Liss, MD and Susan M. Tarlo, MBBS, FCCP
Abstract
Background: Little is known regarding the factors associated with the times for patients’ first physician visit, the first physician suspicion of work-related asthma (WRA), and final diagnosis after the onset of WRA symptoms. This study examined individual and work-related factors that are associated with longer times to these diagnostic milestones among groups with occupational asthma (OA) and work-exacerbated asthma (WEA).
Method: Suspected WRA cases were identified from an occupational lung disease clinic and claimants to the Ontario Workplace Safety and Insurance Board (100 patients each). Questionnaire administration and chart review were undertaken.
Results: Eighty participants were classified as having sensitizer-induced OA and 87 as having WEA. For the OA group, the risk factors for delay included male sex, being unmarried, low education, and lack of awareness of association of symptoms with work. Other factors included older age, being the sole income earner, and lack of knowledge of the Workplace Hazardous Materials Information System program. For WEA, lower household income, lower education, absence of a health-and-safety program at work, absence of a union, and lack of awareness of OA and of agents at work that could affect asthma significantly increased the time to diagnostic milestones.
Conclusions: Different factors affect the diagnostic milestones for OA and WEA. Findings suggest a need for educational programs for workers who are at risk of OA and WEA and a need for further primary care physician education on WRA.
Key Words: asthma . diagnosis . occupational asthma . socioeconomic factors . work-exacerbated asthma . workplace . work-related asthma
