Muzaffer METİNTAŞ, Necla ÖZDEMİR, Sinan ERGİNEL, İrfan UÇGUN, Mustafa KOLSUZ

Eskişehir merkezinde oto ve mobilya boyacılarında mesleksel astım tanısında zirve akım hızı (PEF) takibinin yeri

Zirve akım hızı (PEF) takibinin mesleksel astım (MA) tanısındaki yerini belirlemek amacıyla, Eskişehir merkezinde oto boyacılığı ve mobilya boyacılığı yapan tüm boyacılar (312 işçi) çalışmaya dahil edilerek klinik, epidemiyolojik ve prospektif 3 aşamalı çalışma planlandı. Onaltı sorudan oluşan anket ve solunum fonksiyon testi çalışmanın ilk aşamasını oluşturdu. Ankette şikayeti olduğunu belirten ve bir ay süreyle PEF takibi yapmayı kabul eden 52 işçiye, iş ve iş harici dönemleri kapsayan seri PEF takibi yapıldı. Kırk tanesinde (%77) yeterli kabul edilebilecek ve MA yönünden değerlendirilebilecek kayıt alındı. Sonuçta min-max değerler grafikle gösterilerek, gün içi ve günler arası PEF değişkenliği görsel olarak değerlendirildi. Yirmibeş tanesinde sonuçlar MA yönünden anlamlı kabul edildi. Yirmiüç işçide (18 tanesi PEF takibi anlamlı, 5'i kayıtları yetersiz) histamin ile nonspesifik bronş provokasyon testi (NSBPT) yapılarak, işle ilgili bronş hiperreaktivitesindeki artma gösterildi. Spesifik bronş provokasyon testi gibi, deneyimli personel ve uygun laboratuvar gerektiren işlemin yapılamadığı ülkemizde, MA tanısında seri PEF takiplerinin kolay, ucuz ve güvenilir bir tanı yöntemi olduğu, yaygın kullanımının sağlanması gerektiği düşünüldü.

The place of peak expiratory flow monitoring in diagnosing occupational asthma in car and furniture painters in the centre of Eskişehir

With the purpose of ascertaining the degree of importance that the monitoring of peak expiratory flow rate (PEFR) in the diagnosis of occupational asthma (OA), a three-phase clinical and epidemiological study was planned, to incorporate all workers (312 in all) involved in car and furniture painting in the centre of Eskişehir. The first phase consisted of a questionnaire and a pulmonary function test. 52 workers who stated a complaint on the questionnaire and who agreed to undergo PEF monitoring for a period of a month were subjected to a PEF monitoring series which included periods both inside and outside working hours. 40 (77%) of these were registered as sufficient for the study and for evaluation in terms of OA. As a result, PEF variations, within the day as well as between days, were evaluated through graphs showing min-max values. In 25 cases the results were accepted as significant in terms of occupational asthma. In 23 workers, an occupation-related increase in bronchial hyperreactivity was shown by means of the non-specific bronchial provocation test. In our country where, due to lack of experienced staff and suitable equipment, procedures like the specific bronchial provocation test cannot be performed, we consider widespread provision of such easy, cheap and reliable methods of OA diagnosis as PEF monitoring to be necessary.

PDF

___

1. Sheffer AL, ed. International consensus report on diagnosis and management of asthma. Eur Respir J 1992; 5: 601-41.
2. Cartier A. Definition and diagnosis of occupational asthma. Eur Respir J 1994; 7:153-60.
3. Chan-Yeung M, Lam S. Occupational Asthma (state of art). Am Reu Respir Dis 1986; 133: 686-703.
4. WS Beckett The epidemiology of occupational asthma. Eur Respir J 1994; 7:161-4.
5. Gannon PF, Burge PS Serial peak expiratory flow measurement in the diagnosis of occupational asthma. Eur Respir J 1997; 24:57-63.
6. Burge PS, O'Brien IM, Harries MG. Peak flow rale records In the diagnosis of occupational asthma due to isocynates. Thorax 1979; 34: 317-22.
7. Çımrın AH, Akpınar M, Akkoçlu A ue ark. Mobilyacı astması (iki olgu nedeniyle): Solunum Hastalıkları 1997; B: 99-102.
8. Cote J, Kennedy S, Chan-Yeung M Quantitative versus qualitative analysis of peak expiratory flow in occupational asthma. Thorax 1993; 48:48-51.
9. Malo JL, Cote J, Cartier A, Boulet LP, L'Archeueque J, Chan-Yeung M. How many times per day should peak expiratory flow rates be assessed when investigating occupational asthma? Am Reu Respir Dis 1993; 147: 111.
10. Quirce S, Contreras G, Dyobuncio A, Chan-Yeung M. Peak expiratory flow monitoring is not a reliable method for establishing the diagnosis of occupational asthma. Am J Crit Care Med 1995; 152:1100-2.
11. Burge PS. Occupational Asthma. In: Brewis RAL, Gibson GJ, Geddes DM (eds). Pulmonary Medicine. London: Bailliere Tindall, WB Saunders, 1991: 704-21.
12. Moscato G, Maestrelli P, Malo JL, et al. Statement on self monitoring of peak expiratory flows in the invesitation of occupational asthma: Official Statement Eur Respir J 1995; 8: 1605-10.
13. Lee HS. Serial peak expiratory flow rate monitoring a useful tool in epidemiological studies on occupational asthma, (abstract) Ann Acad Med Singapore 1994; 23: 725-30.
14. Perrin B, Lagier F, L'Archeueque J, et al. Occupational asthma: validlty of monitoring of peak expiratory flow rates and non-allerjik bronchial responsiveness as compared to specific inhalation challenge. Eur Respir J 1992; 5:40-8.
15. Liss GM, Tarlo SM. Peak expiratory flow rates in possible occupational asthma. Chest 1991; 100:63-9.
16. Burge PS. Diagnosis of occupational asthma. Ciln Exp Allergy 1989; 19: 649-52.
17. Banks DE, Tarlo SM, Masri F, et al Bronchoprovocation tests in the diagnosis of isocyanate-induced asthma. Chest 1996; 109: 1370-9.
18. Tarlo SM, Broder I. Outcome of assessments for occupational asthma. Chest 1991; 100:329-35.