职业性哮喘和工作诱发哮喘发作患者的呼气峰流速变异率的比较
2008/02/07
PEF(呼气峰流速)监测对职业性哮喘（OA）的诊断帮助很大。同时，在工作诱发的哮喘（WEA）患者在工作和脱离工作时PEF的变异率尚没有可靠的资料进行相关研究和分析。因此，加拿大学者Catherine Lemière等对OA和WEA患者在工作和脱离工作时的PEF变异率进行了相应的研究。这些患者OA或WEA的诊断均通过特异性过敏源激发试验建立。患者进行连续2周的PEF监测，分别在工作和脱离工作时，并计算出PEF变异率。PEF图形可通过五个变量的可视性指标直接分析进行解释，并经计算机统计（Oasys-2）进行处理和分析（该软件可从下列网站：www.occupationalasthma.com获取）。共34名患者（WEA15名，OA19名）参加了本次研究，PEF变异率在OA患者和WEA患者均达到较高水平，（OA为19.8±8.7% vs 10.7±6.3%，p < 0.001；WEA 为14.2±4.8% vs 10.6±5.6%, p=0.02)，OA 尤为明显(p=0.02)。但可视性指标和Oasys-2软件无法鉴别OA和WEA。
因此，本研究提示：虽然OA比WEA的PEF变异率更明显，但无论可视性指标抑或相应软件均无法区分两者。
因此，本研究提示：虽然OA比WEA的PEF变异率更明显，但无论可视性指标抑或相应软件均无法区分两者。
（汤葳 上海交通大学附属瑞金医院呼吸科 200025 摘译）
(Chest. 2007; 132:483-488)
(Chest. 2007; 132:483-488)
Comparison of Peak Expiratory Flow Variability Between
Workers With Work-Exacerbated Asthma and Occupational
Asthma*
Samah Chiry, MD; André Cartier, MD; Jean-Luc Malo, MD; Susan M.
Samah Chiry, MD; André Cartier, MD; Jean-Luc Malo, MD; Susan M.
Tarlo, MD, FCCP and Catherine Lemière, MD, MSc
* From Hôpital du Sacré-Cœur de Montréal (Drs. Chiry, Cartier, Malo,
* From Hôpital du Sacré-Cœur de Montréal (Drs. Chiry, Cartier, Malo,
and Lemière), Montréal, QC; and Gage Occupational and Environmental
Health Unit (Dr. Tarlo), Toronto Western Hospital,Toronto, ON, Canada.
Correspondence to: Catherine Lemière, MD, MSc, Department of Chest
Correspondence to: Catherine Lemière, MD, MSc, Department of Chest
Medicine, Sacré-Coeur Hospital, 5400 Gouin West, Montreal,QC, Canada
H4J 1C5; e-mail: catherine.lemiere@umontreal.ca
Abstract
Background: Peak expiratory flow (PEF) monitoring is frequently used
Abstract
Background: Peak expiratory flow (PEF) monitoring is frequently used
to diagnose occupational asthma (OA). The variability of PEF between
periods at work and away from work has not been described in workers
with work-exacerbated asthma (WEA). We sought to assess and compare
the diurnal variability of PEF during periods at and away from work
between subjects with OA and WEA.
Methods: Workers referred for work-related asthma underwent PEF
Methods: Workers referred for work-related asthma underwent PEF
monitoring for 2 weeks at and away from work. The diagnostic of OA or
WEA was subsequently made according to the respective positivity or
negativity of the specific inhalation challenges. PEF mean diurnal
variability was calculated during periods at and away from work. PEF
graphs were also interpreted using direct visual analysis by five
observers and using a computer program (Oasys-2, Expert System )
[available at: http://www.occupationalasthma.com].
Results: Thirty-four subjects were investigated (WEA, n=15; OA, n=19).
Results: Thirty-four subjects were investigated (WEA, n=15; OA, n=19).
There was a greater variability of PEF at work than away from work in
both OA (19.8 ± 8.7% vs 10.7 ± 6.3%, p < 0.001) and WEA (14.2 ± 4.8% vs
10.6 ± 5.6%, p = 0.02). However, the magnitude of the variability was
higher in OA than in WEA (p = 0.02). The visual interpretation of PEF or
the Oasys-2 program failed to distinguish WEA from OA.
Conclusion: Although workers with OA showed a higher PEF variability than
Conclusion: Although workers with OA showed a higher PEF variability than
workers with WEA when at work, clinicians were unable to reliably
differentiate OA from WEA using the visual interpretation of PEF graphs or
the computerized analysis.
Key Words: occupational asthma • peak expiratory flow • work-exacerbated
Key Words: occupational asthma • peak expiratory flow • work-exacerbated
asthma
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