Praćenje vršnog ekspiratornog protoka u dijagnozi profesionalne astme

• Published in: Archives of Industrial Hygiene and Toxicology
• Main Authors: Skroza, Dina, Macan, Jelena
• Format: Article in Journal/Newspaper
• Language: Croatian
• Published: Institute for Medical Research and Occupational Health 2018
• Subjects: astma pogoršana radom; bronhoprovokacijski testovi; dišni iritansi; PEF; profesionalni alergeni; bronchoprovocation testing; occupational allergens; respiratory irritants; work-aggravated asthma; Protoka; sami
• Online Access: https://hrcak.srce.hr/213663; https://hrcak.srce.hr/file/312248

Prema podacima iz Registra profesionalnih bolesti Hrvatskoga zavoda za zaštitu zdravlja i sigurnost na radu, u posljednjih deset godina (2008. ‒ 2017.) prijavljeno je samo 20 slučajeva profesionalne astme od ukupno 2234 prijavljene profesionalne bolesti. To upućuje na značajne nedostatke u prepoznavanju toga poremećaja u našoj radnoj populaciji. Cilj ovoga rada bio je opisati standardnu metodu praćenja vršnog ekspiratornog protoka zraka (eng. peak expiratory flow, PEF) i predložiti praktičnu smjernicu za korištenje te dijagnostičke metode u ambulantama medicine rada i sporta. Praćenje vršnog ekspiratornog protoka zraka (PEF-monitoring) jednostavna je, jeftina, neinvazivna i pouzdana metoda za utvrđivanje funkcije dišnog sustava u stvarnim uvjetima rada i radnog okoliša. Sadašnje smjernice preporučuju PEF-monitoring kao inicijalnu dijagnostičku metodu prilikom sumnje na profesionalnu astmu. Pozitivan test upozorava na povezanost promjene plućne funkcije s radnom izloženošću i važan je dio dijagnostičkoga procesa utvrđivanja profesionalne astme. Najveći je nedostatak te metode da se tim testom ne može utvrditi uzrok astme, tj. on ne razlikuje profesionalnu astmu od astme pogoršane na radu, nema standardizirane metode za interpretaciju rezultata, a mjerenja provode sami radnici pa su moguće namjerne i nenamjerne manipulacije rezultatima mjerenja. U radu je predložena praktična smjernica za primjenu te metode u ambulantama medicine rada i sporta, s preporukama protokola mjerenja PEF-a, prikaza rezultata mjerenja i njihove interpretacije u sklopu dijagnosticiranja profesionalne astme. According to the ten-year (2008-2017) data of the national Register of Occupational Diseases (Croatian Institute for Health Protection and Safety at Work), of the 2,234 registered cases of occupational diseases only 20 were of occupational asthma. Such underreporting points to poor diagnosing and recognition of this disorder in our working population. The aim of this paper was therefore to address this issue by introducing the standard method for peak expiratory flow (PEF) monitoring as a helpful tool in diagnosing occupational asthma. PEF monitoring is a relatively simple, inexpensive, noninvasive, and robust method for determining the function of the respiratory system in real working conditions and environment. Current guidelines recommend PEF monitoring as an initial diagnostic tool for cases of suspected occupational asthma. A positive test points to associations between changes in the lung function and work exposure and makes an important part in the procedure confirming suspect occupational asthma. However, this test cannot determine the cause of asthma because it does not distinguish occupational asthma from work-aggravated asthma, interpretation of results is not standardised, and its measurements are carried out by workers themselves, which may allow intentional and unintentional errors in measurements. This paper also brings a practical guide for occupational and sport medicine physicians to use this diagnostic method in their practices. Special focus is given to the PEF measurement protocol and the presentation and interpretation of its findings.