Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures?
Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures?
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职业性哮喘调查：临床医生是否未能识别相关职业暴露？
DOI：
10.1155/2015/519123
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发表时间：
2015
影响因子：
2.2
通讯作者：
Lemière,Catherine
中科院分区：
文献类型：
--
作者：
deOlim,Carlo;Bégin,Denis;Boulet,Louis-Philippe;Cartier,André;Gérin,Michel;Lemière,Catherine
背景：特异性吸入激发试验（SIC）能够识别职业性哮喘（OA）的致病因子。临床医生可能无法在工作场所识别特定的代理人，这可能会导致误诊。职业病学家进行的专家评估方法已被用来评估职业暴露在流行病学study.Objective：本研究的主要目的是评估的贡献，由职业病学家进行的专家评估OA的诊断。具体的目的是比较由职业卫生学家和胸科医生在SIC阳性受试者和哮喘受试者中确定的工作场所暴露，但SIC为阴性。方法：在120例病例中进行了SIC：67例阳性，53例阴性。临床医生在执行SIC之前的常规临床评价期间评估了致敏物的职业暴露。职业暴露的专家评估由职业卫生学家盲目的结果SIC.RESULTS：职业卫生学家确定的致病剂阳性SIC的61例中的96.7%。在33例（62.3%）SICs阴性的病例中，职业免疫学家发现了≥1种临床医生未发现的致敏因子。结论：职业免疫学家发现了几乎所有OA患者的致病因子。相比之下，临床医生未能在>60%的阴性SIC受试者中识别出潜在的致敏剂暴露，这可能导致一些受试者被误诊为未患OA。
BACKGROUND: Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies.OBJECTIVE: The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare work‐place exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC.METHODS: SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC.RESULTS: The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician.CONCLUSION: The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA.