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한국에서 이소사이아네이트에 의한 직업성 천식의 현황과 조기 진단에 관한 연구
김유영(You Young Kim),조상헌(Sang Heon Cho),윤호주(Ho Joo Yoon),민경업(Kyung Up Min),백도명(Do Myung Paik),정규철(Kyu Chull Chung) 대한내과학회 1994 대한내과학회지 Vol.47 No.4
N/A Objectives: To evaluate the prevalence of isocyanate -induced asthma in Korea and to develop strategies for early diagnosis and prevention of occupational asthma, we performed this study. Methods: Medical questionaire, prick skin tests with isocyanate and common inhalant allergens, measurements of serum total IgE and isocyanate specific IgE, serial measurements of peak expiratory flow rate and methacholine bronchial challenge test were per- formed in 140 workers from three factories using isocyanate. The medical questionaire included symptoms and their relation to works. Bronchial provocation test using isocyanate was performed in workers who were sus- pected to be occupational asthmatics. Isocyanate concentration of work place was also measured. Results: 1) 32 among 140 workers complained of asthmatic symptoms greater than grade 2.16 among 32 symptomatic workers told that their symptoms had improved during holidays on questionaire. 2) 66 among 140 workers were atopics, The most common allergen was house dust mite. Only one worker showed positive skin prick test to isocyanate, whereas two workers showed papular skin responses a day later. 3) 5 workers showed positive responses to methacholine bronchial provocation. 2 of them were proved to be isocyanate-induced asthmatics. And another one who were confirmed as an isocyanate-induced asthmatic had shown negative response to metacholine, but he con- verted to positive response to metacholine provocation test after provocation test with isocyanate. 4) 7 workers showed weekly variation greater than 20% on serial peak expiratory flow rate measurements. Among them, 2 workers were proved to be isocyanate-induced asthmatics. 5) Isocyanate-specific IgE antibodies were detected in 21 workers. 6) Isocyanate bronchial provocation tests were performed in 21 workers who were suspected to be occupational asthmatics. 3 workers showed early asthmatic responses. 7) The isocyanate concentrations in the air of workplaces were less than 0.005 ppm, mean exposure limit for 8 hours. Conclusion: The prevalence of isocyanate-induced asthma was 2.14%. It is recommended that the workers who are going to be employees of isocyanate using factories should be nonatopic and not have bronchial hyperresponsiveness nor asthma symptom. For early diagnosis of occupational asthma, medical questionaire, serum IgE, and methacholine bronchial provocation test should be performed at the time of regular health examination, and then serial measurements of peak expiratory flow late is needed in whom are sespected to be occupational asthmatics, And bronchial provocation test with isocyanate should be performed for definite diagnosis.