哮喘联盟

   摘要
   背景: 目前，尚没有研究评估特异性吸入激发试验中（SIC）中，鼻腔及支气管对二异氰酸酯诱发哮喘患者在特殊吸入激发试验中（SIC）的鼻腔及气管的反应。
   目的: 本研究实施的目的是评估在二异氰酸酯导致疑似职业性哮喘患者， 应用SIC（二异氰酸酯）时的鼻腔反应（鼻腔和口腔部呼吸道）。
   方法: 14例具有疑似二异氰酸酯导致诱发职业性哮喘病史的患者，在7立方米的空间内，接受二异氰酸酯SIC刺激。通过鼻声反射、鼻吸气流量峰值（PNIF）和视觉模拟评分（VAS）来评估鼻腔反应，同时也对支气管反应进行了评估。在观察气道反应的同时，鼻腔反应测试在刺激时同时进行测量，参数包括鼻声反射，峰值鼻吸气流速（PNIF）和视觉模拟评分（VAS）。
   结果: 11例个患者对二异氰酸酯出现了明显的哮喘样反应。没有患者曾经有明确的工作职业相关的鼻部症状。在对二异氰酸酯刺激出现阳性支气管反应的患者中，较基线值相比，鼻腔平均最小交叉区域横截面积(MCA)下降了26.9%，鼻腔容量5cm处降低了33.5%，PNIF降低了28.3%。在对二异氰酸酯刺激出现阳性鼻腔反应的患者中，分别引起45％，54％和45％的下降。在4例患者中观察到VAS显著的增加。3例阴性支气管反应患者中，观察到鼻腔反应也呈阴性。
   结论: SIC揭示：在大约50％由于二异氰酸酯引发职业性哮喘的患者存在客观的鼻腔反应，尽管这些患者中没有报道过与工作职业相关的鼻腔症状。这一发现的临床意义是：二异氰酸酯引发职业性哮喘的患者工作时的鼻部症状与二异氰酸酯SIC时客观存在的鼻部反应的关联较差。
 

（苏欣 审校）
Rhinology. 2014 Dec;52(4):431-6. doi: 10.4193/Rhin14.005.

 

Nasal response in patients with diisocyanate asthma.
 

Sastre J, Poltronieri A, Mahillo-Fernandez I, Aguado E, Garcia Del Potro M, Fernandez-Nieto M.
 

ABSTRACT
BACKGROUND: To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC).
OBJECTIVES: This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents.
METHODS: Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses.
RESULTS: Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response.
CONCLUSION: SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.
 

Rhinology. 2014 Dec;52(4):431-6. doi: 10.4193/Rhin14.005.