农药喷洒工哮喘患者的哮喘症状急性加重
2013/07/17
摘要
目的：哮喘急性加重是哮喘管理的关键问题。我们研究对于农药喷洒工哮喘患者，哮喘症状急性加重是否与农业暴露有关。
方法：入组对象均为伴有哮喘发作（过去12个月内出现气喘和呼吸困难）的农药喷洒工，且完成了农业健康研究（AHS）入组问卷。哮喘急性加重定义为过去12个月内有过因气喘或喘鸣入急诊或门诊。研究的农业暴露因素包括过去12个月内使用的36种特定杀虫剂以及各样农业活动。使用logistic回归评估校正比值比（ORs），控制潜在混淆因素。
结果：纳入926例AHS伴哮喘发作的成人农药喷洒工，其中202名（22%）伴有哮喘急性加重。发现与哮喘加重成负相关的因素包括两种除草剂（草甘膦，OR=0.5,95% CI（可信区间）0.3,0.8；百草枯，OR=0.3,95%CI 0.1,0.9）和一些农业活动（修理机器，碾磨金属，开柴油拖拉机和兽医操作）。只有在过敏性哮喘患者中（如，医生诊断枯草热或湿疹，46%），哮喘急性加重与杀虫剂呈正相关，如除草剂二甲戊灵（OR=2.1,95%CI 1.1,4.1）和杀虫剂涕灭威（OR=10.2,95%CI 1.9,55）。
结论：两种杀虫剂和一些特定农业活动与哮喘加重成负相关，哮喘患者如果避免诱发症状的农业暴露可能倾向于使哮喘加重，这两种情况是一致的。尽管受小样本和横断面研究设计的限制，本研究提示某些特定杀虫剂可能促发过敏性哮喘患者急性加重。
（苏楠 审校）
Int Arch Occup Environ Health. 2013 May 14. [Epub ahead of print]
Exacerbation of symptoms in agricultural pesticide applicators with asthma.
Henneberger PK, Liang X, London SJ, Umbach DM, Sandler DP, Hoppin JA.
Abstract
PURPOSE: Exacerbation is a critical event in asthma management. We investigated whether exacerbation of symptoms is associated with farming exposures among agricultural pesticide applicators with asthma.
METHODS: Participants were pesticide applicators with active asthma (wheezing and breathing problems in past 12 months) who completed enrollment questionnaires for the Agricultural Health Study (AHS). Exacerbation of asthma was defined as having visited a hospital emergency room or doctor for an episode of wheezing or whistling in the past 12 months. Exposures of interest were using 36 specific pesticides in the past 12 months and conducting various agricultural activities. Adjusted odds ratios (ORs) were estimated by logistic regression while controlling for potential confounders.
RESULTS: The 926 AHS adult pesticide applicators with active asthma included 202 (22 %) with exacerbation. Inverse associations with exacerbation were observed for two herbicides [glyphosate, odds ratio (OR) = 0.5, 95 % confidence interval (CI) 0.3, 0.8, and paraquat, OR = 0.3, 95 % CI 0.1, 0.9] and several agricultural activities (repairing engines, grinding metal, driving diesel tractors, and performing veterinary procedures). Only asthma cases with allergies (i.e., doctor-diagnosed hay fever or eczema, 46 %) had positive exacerbation-pesticide associations, with OR = 2.1 (95 % CI 1.1, 4.1) for the herbicide pendimethalin and OR = 10.2 (95 % CI 1.9, 55) for the insecticide aldicarb.
CONCLUSIONS: The inverse associations with two pesticides and specific farm activities are consistent with the possibility that asthma cases prone to exacerbation may avoid exposures that trigger symptoms. Although limited by small sample size and a cross-sectional design, our study suggests that use of specific pesticides may contribute to exacerbation of asthma among individuals with allergies.
Int Arch Occup Environ Health. 2013 May 14. [Epub ahead of print]
