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ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ57—2002
Diagnostic Criteria of Occupational Asthma
Diagnostic Criteria of Occupational Asthma2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
Article 6.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if the original standard GB16377-1996 is inconsistent with this standard, this standard shall prevail. Many chemical substances are sensitizing and can cause asthma in sensitized individuals. Among common industrial chemicals, there are no less than 200 substances that can cause allergic asthma. In order to protect the health of contacts and effectively prevent and treat occupational asthma, this standard is formulated based on the progress of clinical and laboratory research in recent years. Appendix A of this standard is an informative appendix, and Appendix B, C, D, and E are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Hospital of Peking University, and the Institute of Occupational Health and Poison Control of the Chinese Center for Disease Control and Prevention, the Second Affiliated Hospital of Shanxi Medical University, the Guangdong Provincial Institute of Occupational Disease Prevention and Control, the Heilongjiang Provincial Institute of Labor Hygiene and Occupational Disease Prevention and Control, and the Guizhou Provincial Institute of Labor Hygiene and Occupational Disease Prevention and Control participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..com Occupational Asthma Diagnosis Standard
GBZ57-2002
Occupational asthma is an airway stenosis disease characterized by intermittent episodes of wheezing and wheezing caused by inhalation of asthma-causing substances in the production environment. Wheezing can be relieved after the asthma-causing substances are removed. 1 Scope
This standard specifies the diagnostic criteria and treatment principles of occupational asthma. This standard applies to the diagnosis and treatment of occupational asthma. 2 Normative References
The clauses in the following documents become the clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties reaching an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For any undated referenced document, the latest version shall apply to this standard.
3 Diagnostic principles
Diagnostic criteria for occupational skin diseases (general principles) Based on the exact occupational history and asthma history, combined with labor hygiene and epidemiological surveys and laboratory data, a comprehensive analysis is conducted to exclude asthma or respiratory diseases caused by other reasons before diagnosis can be made. 4 Observation subjects
Those who have chest tightness, shortness of breath, cough, sputum, and paroxysmal asthma, wheezing can be heard in both lungs, but lack specific laboratory index abnormalities; or those who are only found to have specific laboratory index abnormalities during physical examination, but lack typical paroxysmal asthma symptoms and signs clinically.
5 Diagnosis and classification criteria
5.1 Mild asthma
Mild asthma can be diagnosed if any of the following occurs: after a latent period of several months or years, chest tightness, shortness of breath, paroxysmal asthma, wheezing in both lungs, and coughing and expectoration. Symptoms can be relieved in a short period of time after being separated from harmful substances; they can recur after re-exposure. And any specific laboratory index is abnormal:
b) The clinical manifestations of asthma are atypical, but there are laboratory signs of increased airway responsiveness (such as positive bronchial provocation test with methacholine or histamine), and any specific laboratory index is abnormal. 5.2 Severe asthma
Repeated asthma attacks occur on the basis of mild asthma, with obvious manifestations of airway hyperresponsiveness, accompanied by emphysema, and persistent obstructive ventilation dysfunction. ..comTreatment principles
Treatment principles
During the acute attack period, the patient should leave the work site as soon as possible and receive symptomatic treatment, such as oxygen inhalation, antiasthmatic drugs, antiallergic drugs and Chinese medicine, etc.; if necessary, adrenal glucocorticoids should be given. For patients with chronic recurrent attacks, in addition to the above treatment, appropriate supportive treatment is also required.
2 Other treatments
6.2.1Observation subjects
Attention should be paid to the occurrence and development of clinical symptoms and signs, and the relationship between symptoms and occupational factors should be established as soon as possible. Necessary laboratory tests should be carried out. If necessary, the patient can temporarily leave the original working environment, or conduct a "leave-recovery" test, and receive symptomatic treatment. 6.2.2Occupational asthma
After the diagnosis is established, the patient should be transferred from the original job immediately, and receive appropriate rest and treatment. Other work can be arranged after recovery. For patients with severe asthma, changes in living and working environment can be considered, symptomatic treatment should be given, and appropriate harmless light work should be arranged according to health conditions. Instructions for the correct use of this standard
See Appendix A (Informative Appendix), Appendix B, C, D, E (Normative Appendix). ..com Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
1 Scope of application of this standard: Limited to personnel who are directly exposed to the following occupational asthma-causing substances (occupational allergens): Isocyanates: toluene diisocyanate (TDI), diphenylmethylene diisocyanate (MDI), hexamethylene diisocyanate (HDI), nonamethylene diisocyanate (NDI), etc.; Phthalic anhydrides: phthalic anhydride (PA), 1,2,4 trimellitic anhydride (TMA), tetrachlorophthalic anhydride (TCPA) b)
Polyamine curing agent: ethylenediamine, diethylenetriamine, triethylenetetramine, etc.; Platinum complex salt:
sisal.
Accurate occupational history and medical history refer to:
Exposure to occupational asthma-causing substances (occupational allergens) within the above range at work; No asthma before engaging in this job:
Developing paroxysmal or reversible asthma, accompanied by lung wheezing, after engaging in this job: There is reliable evidence that asthma attacks are closely related to their occupation, that is, asthma occurs after exposure, while symptoms improve or disappear on holidays, and may recur after further exposure: Immediate allergic reaction mediator blockers, antihistamines and adrenal glucocorticoids all have preventive and therapeutic effects;
The length of service is generally more than half a year.
Specific laboratory index abnormalities are limited to: a)
Positive occupational (on-site) bronchial provocation test: positive indoor allergen bronchial provocation test; b)
Positive antigen-specific IgE antibody test (radioallergen adsorption test--RAST or enzyme-linked immunosorbent test--ELIST);
d) Repeated positive allergen skin test (intradermal, prick or scratch method). 4 When diagnosing this disease, it should be differentiated from upper respiratory tract infection, chronic asthmatic bronchitis, cardiac asthma, exogenous allergic pulmonary A.4
bubble inflammation and non-occupational bronchial asthma. ..comB.1 Patch test
Appendix B
(Normative Appendix)
Specific allergen skin test
According to Appendix C (Normative Appendix) of GBZ18, the specific allergen skin test shall be implemented. B.2 Intradermal test
B.2.1 Operation steps
B.2.1.1 Routinely disinfect the outer side of the subject's upper arm. B.2.1.2 Use a sterilized 1ml tuberculin syringe and a 26-27 gauge intradermal injection needle to extract the skin test solution and inject about 0.02-0.1ml into the skin. The local skin will appear pale and round with a diameter of 3-4mm. There should be no bleeding. B.2.1.3 Perform an antigen-solvent control test on another upper arm at the same time. B.2.2 Observation and judgment
Observe the reaction results 15 to 20 minutes after injection. The judgment criteria are as follows: The test local skin has no reaction, or only small papules or erythema reactions similar to the control appear (A) The test local skin has papules with a diameter of less than 0.5 cm and a less obvious erythema reaction (B) The test local skin has papules with a diameter of 0.5 to 1.0 cm and erythema reaction (+) The test local skin has papules with a diameter of 1.1 to 1.5 cm and obvious erythema reaction (++) The test local skin has papules with a diameter of 1.1 to 1.5 cm and obvious erythema reaction (C) The diameter of the skin papule is greater than 1.5cm, with obvious erythema reaction and pseudopodia (+++). The local skin reaction of the test subject is the same as (+++), and systemic reactions such as itching, flushing, irritation, asthma and other symptoms appear at the same time (++++)
B.2.3 Precautions
Skin test should be carried out during the remission period of the disease:
b) Patients with obvious skin scratching are not suitable for skin test; c)
Antihistamines should be discontinued before the test, and adrenal glucocorticoids should be discontinued when conditions permit. The antigens used should be sterile and of appropriate concentration. The test operation should be accurate and should not cause bleeding; attention should be paid to whether there is a systemic reaction, and emergency drugs should be prepared in case of emergency. e)
B.3 Scratch test
B.3.1 Operation steps
B.3.1.1 Routinely disinfect the skin on the outer side of the upper arm or inner side of the forearm of the subject and wash it with distilled water or saline. B.3.1.2 After the skin is dry, use the needle tip to make a direct scratch. Each scratch is 3 to 5 mm long. Be careful to prevent bleeding. ..comB.3.1.3 Drop the skin test solution on the scratch.
B.3.1.4 Use the antigen solvent to perform a control test. B.3.2 Observation and judgment
Observe the reaction results 15 to 20 minutes after the scratch. The judgment criteria are as follows: The scratched skin is the same as the control test (i) The scratched skin is slightly raised, with light red spots around it (x) The scratched skin has papule-like protrusions, which are longer than the length of the scratch and are surrounded by obvious red spots (++)
The scratched skin papules are raised and have pseudopodia, and are surrounded by obvious irregular red spots (+++) The scratched skin papules have more than two pseudopodia, itchy, and the surrounding skin is obviously red and swollen (++++) B.3.3 Precautions
Same as B2.3.
If a strong skin reaction occurs within 15 minutes after the skin test, the antigen can be removed with cotton dipped in distilled water to prevent further development of the reaction.
B.4 Prick test
B.4.1 Operation steps
B.4.1.1 Routinely disinfect the inner side of the front tube or the outer side of the upper arm of the subject. B.4.1.2 First drop a drop of skin test solution on the skin test site. B.4.1.3 Use a special pricking needle (or a common injection needle instead) to pierce 0.51mm in the center of the skin where the skin test solution is dropped, parallel to the skin surface, and then slightly raise the needle tip to allow the skin test solution to flow into the skin, and then quickly withdraw the needle. 1 minute after the pricking, use a filter paper strip to absorb the excess skin test solution. The entire operation should not bleed. B.4.1.4 Use an antigen solvent for a control test. B.4.2 Observation and judgment
Observe the reaction 15 to 20 minutes after the pricking. The judgment method can directly record the diameter of the wheal and erythema, and compare it with the control to determine whether it is positive (the normal control should have no wheal or only a small skin mound with a diameter of less than 3mm, and no red halo around it).
B.4.3 Precautions
Same as B2.3.
..comC.1 Principle
Appendix C
(Normative Appendix)
Antigen-specific IgE determination Radioallergen adsorption test (RAST) cross-links allergens to solid phase polymers, such as glucose gel, cellulose particles or paper, and then adds specific antibodies (IgE, etc.) in the serum of the test subject to bind to the allergens, washes off the excess serum, adds 12I-labeled anti-IgE conjugates, and after a certain period of incubation, finally forms a solid phase carrier-allergen-specific IgE-anti-IgE, 125I complex. Wash off the excess labeled antibodies. The content of specific IgE in serum can be known by measuring the amount of radioactive substances left on the paper with a gamma-ray counter.
C.2 Equipment
Xinhua filter paper or Whatman No. 1 filter paper, micro-liquidator, Buchner filter paper, gamma-ray counter, negative pressure aspirator, magnetic stirrer, pH meter or test paper.
C.3 Reagents
a) Allergens;
b) Cyanogen bromide;
c) 0.01mol/L (pH7.4) phosphate buffer: d) 5mol/L potassium phosphate solution:
e) 0.005mol/L, 0.1/L sodium bicarbonate solution; f) Horse anti-human IgE-IgG:
g) Acetone;
h) 1mol/L, 0.05mol/L ethanolamine
i) 0.1mol/L (pH4.0) acetic acid-sodium acetate buffer: i) bovine serum albumin, or human serum albumin (HSA). C.4 Methods
C.4.1 Preparation of cyanogen bromide activated filter paper
Whatman No. 1 or Xinhua filter paper, use a punch to punch into 6mm diameter paper (100 pieces are about 300mg). Weigh 4g of cyanogen bromide and add 80ml of double distilled water, dissolve in a water bath, and stir. Weigh 4g of paper and put it in a cork-stoppered flask, and soak it in cold double distilled water for 30min. Aspirate the distilled water and add 80ml of 5% cyanogen bromide solution. Adjust the pH to about 11 with 5mol/L pre-cooled phosphate, stir for 8min, and adjust the pH value continuously. Then wash with 800ml of 0.005mol/L sodium bicarbonate for 5 times, and then wash with 400ml of double distilled water for 3 to 4 times. Finally, wash with 400ml of acetone for 4 times, put it into a large flat blood and drain it.
C.4.2 Preparation of antigen (depending on the type of antigen) C.4.3 Coupling protein: Weigh 30mg of HSA and dissolve it with 60ml of 0.1mol/L sodium bicarbonate. Put 15ml of HSA solution into every 200 paper pieces, and rotate the drum at 8℃ for 48h. Wash with 0.1mol/L sodium bicarbonate 3 times, and 0.01mol/L (pH7.4) PBS 3 times.
C.4.4 Antigen coupling: Prepare antigen of appropriate concentration, add it to the paper, drum at 8℃ for 48h, and then wash it with 0.01mol/L (PH7.4) PBS solution 3 times.
..comC.4.5 Blocking: Add 15ml of 0.25mol/L ethanolamine to the above paper, SC, drum for 8h, wash 3 times with 0.1mol/L sodium bicarbonate, wash 3 times with 0.1mol/L (pH4.0) acetic acid-sodium acetate, and wash 3 times with 0.01mol/L (pH7.4) PBS. Store at 4℃ for later use.
C.4.6 RAST test steps
C.4.6.1 Place the paper coupled with antigen and protein at the bottom of the test tube, 1 piece per tube. C.4.6.2 Add 50uL of the serum to be tested to the filter paper disc at a certain dilution concentration (generally 1:5) per tube, and take 50uL of buffer and negative serum respectively, and add them to the filter paper disc as a control, cover, and incubate at room temperature for 3 hours. C.4.6.3 After removing the liquid from each tube with a negative pressure aspirator, wash it three times with 0.05mol/L (PH7.4) PBS containing 0.3% horse serum.
C.4.6.4 Add 50μL of /2I-labeled horse anti-human IgE antibody (about 5 to 80,000 CMP) to each tube of filter paper disc. Incubate at room temperature overnight, and then wash it three times according to the above method.
C.4.6.5 After absorbing, use a Y counter to measure the radioactivity intensity (CPM/min) and compare it with normal people. If the score is greater than two standard deviations (2SD) of the normal mean, it is positive.
D.1 Principle
Appendix D
(Normative Appendix)
Antigen-specific IgE determination—enzyme-linked immunosorbent assay (ELIST) Allergens are bound to a solid phase carrier, a concave polystyrene plate, and the serum to be tested is added to allow specific antigen-antibody binding to occur. Then, a second antibody labeled with horseradish peroxidase (horse anti-human IgE) is added to form an antigen-antibody-antibody complex. After substrate color development, the OD value is measured by an enzyme-labeled immunosorbent assay to determine the content of specific antibodies in the serum.
D.2 Equipment
Concave polystyrene plate, micro-liquidator, enzyme-labeled immunosorbent assay, pH test paper, constant temperature box, refrigerator, washing bottle, wet box, common glass instruments, etc.
3 Reagents
Human serum albumin (HSA) (0.05%); Allergens;
0.02mol/L (PH7.4) phosphate buffer (PBS): Tween-20 (Tween-20) (add 0.05ml to every 100ml PBS solution to make PBS-T); bovine serum albumin (BSA) or calf serum (10%); 0.05mol/L (PH9.6) carbonate buffer: pH5.0 phosphate-citrate buffer;
o-phenylenediamine (OPD);
30% hydrogen peroxide:
Horseradish peroxidase-labeled horse anti-human IgE: k)
2mol/L sulfuric acid.
D.4 Methods
Coated with HSA, 37℃, 2h.
Washed 3 times with PBS-T.
Add allergens at 4℃ overnight.
Wash 3 times with PBS-T.
Add serum to be tested (diluent is PBS-T, containing 1% BSA, 1:5 dilution) at 37℃, 90min. Wash 6 times with PBS-T.
Add enzyme-labeled antibody, 37℃, 90min.
D.4.8Wash 8 times with PBS-T.
Add substrate solution 0.02% OPD, containing 1uL/10ml hydrogen peroxide, 37℃, 30minD.4.9
Terminate the reaction with 2mol/L sulfuric acid
Measure the OD value with an enzyme-linked immunosorbent assay, with a wavelength of 492nm. Result judgment: Positive if it is greater than 2SD of the normal mean. E.1 Indoor allergen heavy bronchoprovocation test
E.1.1 Preparation and basic conditions before the test
Appendix E
(Normative Appendix)
Allergen bronchial provocation test
E.1.1.1 Conducted during the asthma remission period (without symptoms). E.1.1.2 Stop using β-adrenergic receptor stimulants and α-adrenergic receptor blockers 8-12 hours before the test, stop using phosphatase inhibitors 18-24 hours before the test, stop using sodium cromolyn and antihistamines 24 hours before the test, and stop using glucocorticoids 3-5 days before the test.
E.1.1.3 Stop smoking and consuming irritating food and drinks within 6 hours before the test, and avoid excessive exercise. E.1.1.4 The subject has no upper respiratory tract infection recently. E.1.1.5 Prepare safety first aid measures, such as oxygen, medicines, etc. E.1.2 Method
This test method has not yet been standardized in China, so at least the following principles should be followed in practice: E.1.2.1 Choose an appropriate and effective bronchial provocation test method. The commonly used methods are: awwW.bzxz.Net
Devilbiss646 nebulizer, take 5 deep breaths at the functional residual position, and release a quantitative aerosol at 0.6s at the beginning of each inhalation:
b) Use Wrights nebulizer for tidal breathing for 2minc) Airway allergy meter (Astograph) produced in Japan to directly measure airway responsiveness. In addition to the above three methods, other methods and nebulizers that meet the requirements and devices that can determine the amount of nebulization can also be used for testing. The diameter of the aerosol particles produced by the nebulizer should be less than 5um on average. E.1.2.2 The amount of antigen in the bronchial provocation test should be based on the minimum dose that the patient is exposed to and can induce bronchial reactions. The 3mm skin mound (++) or 200 protein nitrogen units/ml or 10-103 (W/V) antigen concentration in the prick test can be used as a reference for the inhaled antigen concentration. When determining the amount of each antigen, the principle of starting with a small dose and gradually increasing the inhaled amount should be followed.
E.1.2.3 Before the test, measure the lung function index (FEV1.0) as the basic value, and the difference between the two results should not exceed 5%: if the antigen is added to a certain diluent, the test after the diluent is inhaled should also be carried out before the antigen is inhaled, as a control value, and the change in this value should not exceed 10% of the basic value.
E.1.2.4 The forced vital capacity in the first second (FEV1.0) can be used as a measurement index for the bronchial provocation test, and other indicators such as airway conductivity (Sgaw) can also be used. The observation interval should not be longer than 15 to 30 minutes within the first 1/J" of inhalation. E.1.2.5 In addition to paying attention to the reaction within 2 hours (mostly 10 to 30 minutes) after inhaling the allergen, attention should also be paid to the remission type or two-way reaction that occurs within 4 to 6 hours. Therefore, the total observation time should reach 24 hours..
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