Towards a better understanding of work-aggravated asthma

工作加重型哮喘（WAA）是一种常见的疾病，迄今为止一直被忽视。广大 该计划的目的是改善WAA的诊断，并评估其社会经济状况。 这种疾病的负担。为了实现这一目标，我们提出以下具体目标。1.To 评价每年转诊的受试者中WAA受试者的比例， 可能与工作有关的哮喘在两个诊所专门在这一领域。2.临床比较， 患有WAA、职业性哮喘（OA）和 哮喘受试者在工作和非工作期间无WAA或OA。3.评估 根据在工作场所暴露于特定制剂的情况，确定发生WAA或OA的风险。 4.比较WAA、OA和OA患者的临床功能和炎症结局， 2年以上无WAA或OA的哮喘患者，并建立WAA的预后因素5. 从工作残疾和卫生资源使用的角度评估《工作残疾津贴法》的经济影响。 方法.研究的第一部分将采用交叉设计，为期2周的工作时间， 3组60名受试者离开工作2周：OA受试者、WAA受试者和 无WAA和OA的哮喘患者。在每一段时间结束时，他们将经历一个 乙酰甲胆碱激发和痰诱导。接下来，一个特定的吸入挑战将是 在患有工作相关性哮喘的受试者中进行，以区分OA和WAA。病例对照研究 将进行，以评估哪种类型的职业代理人可能会诱发WAA。 研究的第二部分将包括一项队列研究，对受试者进行两年随访 有OA、WAA和无OA而无WAA的哮喘患者。受试者将每年随访一次，持续2年 通过肺量测定、乙酰甲胆碱激发和痰诱导。哮喘的发生 将记录恶化。WAA的经济影响将根据工作进行评估 残疾和卫生资源的使用，并与OA和哮喘无OA而非WAA进行比较。

Work-aggravated asthma (WAA) is a frequent condition that has been so far overlooked. The broad objective of this program is to improve the diagnosis of WAA and to assess the socio-economic burden of this disease. In order to reach this objective, we propose the following specific aims. 1.To evaluate the proportion of subjects with WAA among the subjects who are referred yearly for possible work-related asthma in two clinics specialized in this field. 2.To compare the clinical, functional and inflammatory characteristics of subjects with WAA, occupational asthma (OA), and asthmatic subjects without WAA nor OA during periods at work and away from work. 3.To evaluate the risk of developing WAA or OA according to the exposure to specific agents at the workplace. 4.To compare the clinical functional and inflammatory outcome of subjects with WAA, OA and asthmatics without WAA nor OA over 2 years and establish prognostic factors for WAA 5.To assess the economic impact of WAA in terms of work disability and use of health resources. Methods. The first part of the study will be of crossover design, with periods of 2 weeks at work and 2 weeks away from work for 3 groups of 60 subjects: subjects with OA, subjects with WAA and asthmatics without WAA nor OA. At the end of each period of time, they will undergo a methacholine challenge and a sputum induction. Next, a specific inhalation challenge will be performed in subjects with work-related asthma to differentiate OA from WAA. Case-control studies will be performed in order to assess which type of occupational agents are likely to induce WAA. The second part of the study will consist in a cohort study with a two-year follow-up of the subjects with OA, WAA and asthmatics without OA not WAA. The subjects will be followed yearly for 2 years by spirometry, methacholine challenge and sputum induction. The occurrence of asthma exacerbations will be recorded. The economic impact of WAA will be assessed in terms of work disability and use of health resources and compared with OA and asthma without OA not WAA.