COMMUNITY BASED STUDY OF ADULT ONSET ASTHMA

哮喘的发病率正在上升，在成年人中，与工作有关的暴露可能 是一个重要因素-职业性哮喘（OA）发病率增加70% 根据最近的一项基于登记的研究，真正的 职业暴露对成人哮喘的影响尚不清楚 因为测量OA的方法给出了相互矛盾的结果。方法 基于临床诊断OA的监测，占<1-5% pf 成人哮喘然而，测量哮喘风险的病例对照方法 研究表明，6-33%的成人哮喘是由以下原因引起的： 工作场所暴露。冲突的发生可能是由于两个因素： 医生往往不能诊断和报告OA，和刺激性暴露 可能会增加患哮喘的风险，而不会引起符合 临床定义。这两个因素都有重要的影响， 正确治疗和预防成人哮喘。我们建议解决 这场冲突。我们将确定成人暴露于刺激物的作用- 同时使用临床和病例对照的发作性哮喘 方法在社区为基础的哮喘发病率的前瞻性研究。的 研究队列将是入组HMO的典型美国工作人群。 研究设计的其他好处是有机会验证 用于暴露评估和检测与工作有关的 哮喘具体而言，我们将：1）调查队列中的事件病例 超过80，000名成年人超过3年，并确定符合比例 OA的临床定义; 2）使用巢式病例对照研究， 按职业和工作场所确定所有哮喘的发病率 3）确定临床OA是否占过量 成人哮喘发病率与工作场所暴露相关 致敏物和刺激物; 4）普罗帕酮跟随哮喘患者两次 诊断后10年，以确定成人发作哮喘对 肺功能，就业，收入和生活质量，并确定 临床OA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，从而对OA进行二级预防。这 这项研究将导致更好的方法来识别哮喘引起的 工作场所接触，从而更广泛地了解OA， 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.