COMMUNITY BASED STUDY OF ADULT ONSET ASTHMA

哮喘发病率正在增加，在成年人中，与工作相关的暴露可能 是一个重要因素-职业性哮喘(OA)发病率增加了70% 根据最近一项基于注册的研究，在过去十年中。真实的 职业性暴露对成人哮喘发病的影响尚不清楚 因为测量办公自动化的方法给出了相互矛盾的结果。方法 根据临床诊断的骨性关节炎的监测，占1%-5%的PF 成人哮喘。然而，衡量哮喘风险的病例对照方法 行业研究表明，6%-33%的成人哮喘是由 工作场所的暴露。发生冲突的原因可能有两个： 医生经常没有诊断和报告骨性关节炎和刺激性暴露 可能会增加哮喘的风险而不会导致符合以下条件的病例 临床定义。这两个因素都对 成人哮喘的适当治疗和预防。我们建议解决 这场冲突。我们将确定刺激性暴露在成人中的作用- 同时采用临床和病例对照的方法发病哮喘 方法以社区为基础的哮喘发病率的前瞻性研究。这个 研究队列将是参加HMO的典型美国工作人口。 研究设计的其他好处是有机会验证 用于暴露评估和工作相关检测的调查问卷 哮喘。具体地说，我们将：1)调查队列中的事件 在3年内超过8万名成年人，并确定符合以下条件的比例 骨性关节炎的临床定义；2)使用嵌套病例对照研究 按职业和工作场所确定所有哮喘的发病率 暴露；3)确定临床上的OA是否占了多余的比例 与工作场所接触以下物质有关的成人哮喘发病率 致敏剂和刺激物；4)预期对哮喘患者进行两次跟踪 确诊后数年以确定成人哮喘对 肺功能、就业、收入和生活质量，并确定 临床骨性关节炎和哮喘的预后是否不同 工作场所刺激性暴露；5)测试旨在增加 适当的临床诊断，从而二级预防骨性关节炎。这 研究将导致改进识别由以下原因引起的哮喘的方法 工作场所的接触，从而更广泛地理解将是 这是今后初级预防工作的重要基础。

Asthma incidence is increasing, and in adults work-related exposures may be an important factor-occupational asthma (OA) incidence increased 70% over last decade according to a recent registry based study. The true contribution of occupational exposures to adult-onset asthma is unknown because the methods for measuring OA give conflicting results. Methods based on surveillance of clinically diagnosed OA account for <1-5% pf adult-onset asthma. However, case-control methods of measuring asthma risk by industry suggest that 6-33% of adult-onset asthma is caused by workplace exposures. The conflict may occur because of two factors: physicians often fail to diagnose and report OA, and irritant exposures may increase the risk the risk of asthma without causing cases that meet the clinical definition. Both factors have important implications for proper treatment and prevention of asthma in adults. We propose to resolve this conflict. We will identify the role of irritant exposure in adult- onset asthma by simultaneously using both clinical and case control methods in a community-based perspective study of asthma incidence. The study cohort will be a typical US working population enrolled in an HMO. Additional benefits of the study design are the opportunities to validate a questionnaire for exposure assessment and for detection of work-related asthma. Specifically, we will: 1) Investigate incident cases in a cohort of over 80,000 adults over 3 years and determine the proportion that meet a clinical definition of OA; 2) Use a nested case-control study to determine the incidence of all asthma by occupation and workplace exposure; 3) Determine whether clinical OA accounts for the excess incidence of adult-onset asthma associated with workplace exposure to sensitizers and irritants; 4) Prospectively follow asthmatics for two years after diagnosis to determine the impact of adult-onset asthma on lung function, employment, income, and quality of life, and to determine whether prognosis differs for clinical OA and for asthma associated with workplace irritant exposure; 5) Test an intervention designed to increase appropriate clinical diagnosis, and thus secondary prevention of OA. This study will lead to improved methods of identifying asthma caused by workplace exposure and thus to a broader understanding of OA that will be an essential foundation for future efforts at primary prevention.