热打印机诱发哮喘
2010/01/07
一位62岁、非吸烟、无特应性体质的女性，在4m3的亭子内从事彩票打印、售票工作后，出现哮喘症状。在过去3年，她的主要工作是用销售点终端机打印彩票。其哮喘症状（包括鼻—结膜炎、面部水肿、咳嗽、呼吸困难和喘息等）常在她到达工作地点30～60分钟后开始发生，离开亭子后数天内症状可逐渐减轻。予吸入支气管扩张剂和口服皮质皮质类固醇可控制症状。患者曾因此3次被送入医院急诊诊治。
该患者特应性检查阴性，基础用力肺活量正常。甲酰胆碱支气管激发试验阳性（PD20-FEV1: 6.18 mg/ml）。 激发后诱导痰中的嗜酸细胞总数高于激发前。8天后，模拟患者工作环境，使用销售点终端机进行激发试验，结果显示暴露1 分钟后，FEV1降低15％，无迟发哮喘反应。24小时后，甲酰胆碱支气管激发试验仍为阳性。此后，她未再从事同样的工作，现未用任何药物，症状消失。
已知丙烯酸酯可诱发职业性哮喘，使用印刷设施的工人因此会受到影响。该病例提示我们，对于暴露于销售点终端设备，并有哮喘症状的患者，应考虑到存在此类职业性哮喘的可能性。
（张清玲 深圳市第二人民医院呼吸内科 518039 摘译）
(N Engl J Med 2009 May;360: 2375-2376)
Silvia Sánchez-Garcia, M.D. , Mar Fernández-Nieto, M.D. , Joaquín Sastre, M.D., Ph.D.
Abstract
A nonsmoking 62-year-old woman without atopy was reported to have asthma symptoms developed after she had worked for selling lottery tickets inside a 4-m3 kiosk. For the past three years, she had been using a point-of-sale terminal to print lottery tickets. The asthma symptoms (including rhinoconjunctivitis, facial edema, cough, shortness of breath , and wheezing) occurred within 30 to 60 minutes after she arrived at her workplace and diminished during days away from the workplace. The patient controlled the symptoms by using inhaled bronchodilators and pulses of oral corticosteroids. She required emergency treatment on three occasion.
There were no signs of atopy; baseline spirometric measurements were normal . The provocative concentration of inhaled methacholine required to reduce the forced expiratory volume in 1 second (FEV1) by 20% (PC20) was 6.18 mg per milliliter (normal value, >16.0 mg per milliliter). The eosinophil count in induced sputum after the challenge was higher than the count at baseline. Eight days later, a challenge was performed in which the patient’s work environment was simulated; using her own point-of-sale terminal. A decrease in FEV1 of 15% was observed 1 minute after exposure, with no late asthmatic reaction. Twenty-four hours after the challenge, she still showed methacholine hyperresponsiveness. She no longer works in the kiosk and is now asymptomatic without the use of any medication.
Acrylates are known causative agents of occupational asthma, and workers in printing facilities
may be affected. The workers who were exposed to these point-of-sale terminal devices and have asthma symptoms should be considered in cases of adult-onset asthma.
Asthma Induced by a Thermal Printer. N Engl J Med 2009 May;360: 2375-2376
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月经周期影响女性哮喘患者肺功能
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