哮喘联盟

   摘要
   目的：旨在评估职业性哮喘(OA)的进展是否取决于患者避免或继续暴露于激发物质。
   方法：研究对象为经特异性吸入激发试验确诊为OA的患者。患者在同一天接受如下检查：临床问诊，体格检查，用力呼吸量测定法测定肺功能，乙酰甲胆碱试验和总lgE测定。在确诊的同时根据GINA标准评估哮喘的严重程度，并基于其改变情况评估预后，即：临床改善，恶化或无改变。
   结果：最终纳入73例患者，其中55例结束暴露，18例在工作室继续暴露。在终止暴露的患者中47%达到临床改善，仍然暴露患者中22%达到临床改善；临床恶化分别为14%和17% (p = 0.805)。针对包括暴露物质的类型以及继续或避免暴露等变量的logistical回归分析结果，并未发现与临床进展相关的任何预测因素。同样，FEV1和支气管高反应性的变化与避免或继续暴露于致病物质无相关性。
   结论：对于OA患者而言，避免暴露于致病物质似乎并不能改善疾病进展。尽管如此，也没有充足的证据来建议对现有管理指南的进行修订。

 

（林江涛 审校）
Respir Med. 2014 Aug 14. pii: S0954-6111(14)00280-7.doi:10.1016/j.rmed.2014.08.001. [Epub ahead of print]

 

Evolution of occupational asthma: Does cessation of exposure really improve prognosis?
 

Munoz X1, Viladrich M2, Manso L3, Del Pozo V4, Quirce S5, Cruz MJ6, Carmona F7, Sánchez-Pla A7, Sastre J3.
 

ABSTRACT
AIM: To assess the evolution of occupational asthma (OA) depending on whether the patient avoids or continues with exposure to the offending agent.
METHODS: Study in patients diagnosed with OA using a specific inhalation challenge. Patients underwent the following examinations on the same day: clinical interview, physical examination, forced spirometry, methacholine test and determination of total IgE. Clinical improvement, deterioration or no change were defined according to the changes seen on the GINA severity scale at the time of diagnosis.
RESULTS: Of the 73 patients finally included, 55 had totally ended exposure and 18 continued to be exposed at work. Clinical improvement was observed in 47% of those who had terminated exposure and in 22% of those who remained exposed; clinical deterioration was observed in 14% and 17% respectively (p = 0.805). Logistical regression analysis, including the type of agent and the persistence or avoidance of exposure among the variables, did not show any predictive factors of clinical evolution. Similarly, the changes in FEV1 and in bronchial hyperresponsiveness were not associated with the avoidance or continuation of exposure to the causative agent.
CONCLUSIONS: Avoiding exposure to the causative agent in patients with OA does not seem to improve prognosis in this disease. Despite these findings, there is insufficient evidence to recommend a change in current management guidelines.
 

Respir Med. 2014 Aug 14. pii: S0954-6111(14)00280-7.doi:10.1016/j.rmed.2014.08.001. [Epub ahead of print]