GB 16377-1996 Occupational asthma diagnostic criteria and treatment principles
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles ofmanagement of occupatlonal asthmaGB 16377-1996
Occupational asthma is an airway constriction disease characterized by intermittent paroxysmal wheezing and wheezing caused by inhalation of inhalants in a production environment. Wheezing can be relieved after the inhalant is removed. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles of occupational asthma. This standard applies to the diagnosis and treatment of occupational asthma. 2 Reference standards
GB7804 Diagnostic criteria and management principles of occupational skin diseases (general principles) 3 Diagnostic 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 Diagnosis and classification criteria
4.1 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 only have specific laboratory index abnormalities found in physical examinations, but lack typical paroxysmal asthma symptoms and signs clinically. 4.2 Mild asthma
Those who have any of the following can be diagnosed as mild asthma: a. After a latent period of several months or years, chest tightness, shortness of breath, paroxysmal asthma, wheezing in both lungs, may be accompanied by cough and sputum. After being separated from harmful substances, the symptoms can be relieved in a short period of time; after re-exposure, they can recur. And have any abnormal specific laboratory index. b. The clinical manifestations of asthma are not typical, but there are laboratory signs of increased airway responsiveness (such as positive bronchial provocation test with methacholine or histamine), and any abnormal specific laboratory index. 4.3 Severe asthma
Recurrent asthma attacks on the basis of mild asthma, with obvious airway hyperresponsiveness, accompanied by emphysema, and persistent obstructive ventilation dysfunction.
5 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, oral medication, anti-allergic drugs and Chinese medicine, and adrenal glucocorticoids when necessary. For chronic recurrent attacks, in addition to the above treatment, appropriate supportive treatment is also required. Approved by the State Administration of Technical Supervision on May 23, 1996 296
Implemented on December 1, 1996
6 Assessment of labor capacity
6.1 Observation object
GB163771996
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 worker may be temporarily removed from the original working environment, or a "removal-recovery" test may be carried out, and symptomatic treatment may be given. 6.2 Occupational asthma
After the diagnosis is established, the worker should be immediately removed from the original job position, and given appropriate rest and treatment. Other work may be arranged after recovery. For patients with severe asthma, consideration may be given to changing the living and working environment, symptomatic treatment, and arranging appropriate harmless light work according to health conditions. Requirements for health examination
Workers who are exposed to asthma should undergo a pre-employment health examination. Regular health examinations should be conducted once a year. The key contents of the physical examination are: medical questioning (respiratory symptoms and other allergic symptoms), heart and lung physical examination, chest X-ray, lung function (VC, FEV1, etc.) and blood eosinophil count, etc. The point observer should further perform laboratory specific index examination. 8 Occupational prohibition certificate
People with obvious specific constitution,
People with obvious heart and lung diseases.
A1 Patch test
Perform according to Appendix A (Supplement) of GB7804. A2 Intradermal test
A2.1: Operation steps
A2.1.1 Routine disinfection of the outer side of the upper arm of the subject. GB 16377-1996
Appendix A
Specific allergen skin test
(Supplement)
A2.1.2 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. A2.1.3 Perform an antigen solvent control test on the other upper arm at the same time. A2.2 Observation and judgment
Observe the reaction results 15 to 20 minutes after injection. The judgment criteria are as follows: No reaction to the test local skin, or only small papules or erythema reactions similar to the control appear. (A) The test local skin has papules with a diameter less than 0.5 cm and less obvious erythema reactions. (B) The test local skin papules have a diameter of 0.5 to 1.0 cm and erythema reactions. (C) The test local skin papules have a diameter of 1.1 to 1.5 cm. cm, with obvious erythema reaction (+) The diameter of the local skin papule of the test subject is greater than 1.5cm, with obvious erythema reaction and pseudopodia (丰)
The local skin reaction of the test subject is the same (册), and systemic reactions such as itching, flushing, breathlessness, wheezing and other symptoms appear at the same time (批) A2.3 Precautions
Skin test should be carried out during the remission period of the disease;
Those with obvious skin scratching are not suitable for skin test. Antihistamines should be discontinued before the test, and adrenal glucocorticoids should be discontinued when conditions permit. The antigen used should be sterile and of appropriate concentration. The test operation should be accurate and should not bleed. d.
Pay attention to whether there is a systemic reaction, and have emergency drugs ready in case of emergency. A3 Scratch test
A3.1 Operation steps
A3.1.1 Routine disinfection of the skin on the outer side of the upper arm or inner side of the forearm of the test subject should be carried out, and washed with distilled water or saline. A3.1.2 After the skin is dry, use the needle tip to make a direct scratch. Each scratch is 3 to 5 mm long. Be careful not to bleed. A3.1.3 Drop the skin test solution on the scratch.
A3.1.4 Perform a control test with an antigen solvent. A3.2 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 (t)
The scratched skin papules are raised and have pseudopodia, and are surrounded by obvious irregular red spots (volume) The scratched skin papules have more than two pseudopodia, itchy, and the surrounding skin is obviously red and swollen (volume) 298
A3.3 Precautions
Same as A2.3.
GB16377-1996
If a strong skin reaction occurs within 15 minutes after the skin test, the antigen can be wiped off with cotton wool and distilled water to prevent further development of the reaction.
A4 Prick test
A4.1 Operation steps
A4.1.1 Routinely disinfect the skin on the inner forearm or outer upper arm of the subject. A4.1.2 First drop a drop of skin test solution on the skin test site. A4.1.3 Use the prepared puncture needle (or use an ordinary injection needle instead) to pierce the center of the skin where the skin test solution is dropped along the skin surface parallel to 0.5~~1mm, then raise the needle tip slightly to allow the skin test solution to flow into the skin, and then quickly withdraw the needle. 1 minute after the puncture, use a filter paper strip to absorb the excess skin test solution. The entire operation should not cause bleeding. Www.bzxZ.net
A4.1.4 Perform a control test using an antigen solvent. A4.2 Observation and judgment
Observe the reaction 15 to 20 minutes after 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 (normal controls should have no wheal or only small skin bumps with a diameter of less than 3mm, without red halo around)). A4.3 Precautions
Same as A2.3.
Appendix B
Radioallergen adsorption test (RAST)
Antigen-specific IgE determination
(Supplement)
The allergen is cross-linked to a solid phase polymer, such as glucose gel, cellulose particles or paper, and then the serum to be tested is added. The specific antibodies (IgE, etc.) in the serum bind to the allergen, the excess serum is washed away, and the 125I-labeled anti-IgE conjugate is added. After a certain period of incubation, a solid phase carrier-allergen-specific IgE-anti-IgE, 125I complex is finally formed. Wash away the excess labeled antibodies. The content of specific IgE in the blood can be known by measuring the amount of radioactive elements left on the paper with a radiation counter. B2 Equipment
Xinhua filter paper or Watman No. 1 filter paper, microfluidizer, Buchner filter paper, radiation counter, negative pressure aspirator, magnetic stirrer, pH meter or test paper.
Allergen,
Cyanogen bromide,
0. 01 mol/L (pH 7.4) phosphate buffer; 5 mol/L potassium phosphate solution,
0.005mol/L, 0.1mol/L sodium bicarbonate solution; horse anti-human IgE-IgG,
acetone,
1 mol/L, 0. 05 mol/L. ethanolamine,299
GB16377—1996
i.0.1mol/L (pH4.0) acetic acid-sodium acetate buffer;j. bovine serum albumin, or human serum albumin (HSA). B4 Method
B4.1 Preparation of cyanogen bromide activated filter paper
Whatman No. 1 or Xinhua filter paper, use a hole puncher to punch into 6mm diameter paper (100 pieces are about 300mg). Weigh 4g cyanogen bromide and add 80mL double distilled water, dissolve in a water bath, and stir. Weigh 4g of paper into a stoppered conical 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 3-4 times. Finally, wash with 400mL of acetone for 4 times, put into a large flat blood and drain. B4.2 Prepare antigen (depending on the type of antigen). B4.3 Coupling protein: weigh 30mg HSA and dissolve it with 60mL of 0.1mol/L sodium bicarbonate. Put 15mL of HSA solution into every 200 pieces of paper and rotate the drum at 8℃ for 48h. Wash 3 times with 0.1mol/L sodium bicarbonate and 3 times with 0.01mol/L (pH7.4) PBS.
B4.4 Antigen coupling: Prepare antigen of appropriate concentration, add to paper, drum at 8℃ for 48h, then wash 3 times with 0.01mol/L (pH7.4) PBS.
B4.5 Blocking: Add 15mL of 0.25mol/L ethanolamine to the above paper, drum at 8℃ 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. B4.6 RAST test steps
B4.6.1 Place the paper coupled with antigen and protein at the bottom of the test tube, 1 piece per tube. B4.6.2 Add 50μL of the serum to be tested to the filter paper disc at a certain dilution concentration (generally 1:5) per tube, and take 50μL of buffer and negative serum respectively, add them to the filter paper disc as a control, cover, and incubate at room temperature for 3h. B4.6.3 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. B4.6.4 Add 50uL of 125I-labeled horse anti-human IgE antibody (about 5~80000CMP) to each tube of filter paper disc. Incubate at room temperature overnight, and then wash it three times according to the above method.
B4.6.5 After aspiration, use a counter to measure the radioactivity (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.
Appendix C
Antigen-specific IgE determination - enzyme-linked immunosorbent assay (ELIST) (supplement)
Bind the allergen to the solid phase carrier concave styrene plate, add the serum to be tested, make it specifically bind the antigen and antibody, then add the second antibody labeled with horseradish peroxidase (horse anti-human IgE), and it will form an antigen-antibody-antibody complex. After the substrate is developed, the OD value is measured by the enzyme-labeled immunosorbent assay to know the content of specific antibodies in the serum. C2 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.
C3 Reagents
a, human serum albumin (HSA) (0.05%); 300
allergen;
GB 16377-1996
0. 02 moi/L (pH 7. 4) phosphate buffer (PBS); Tween-20 (Tween-20) (add 0.05 mL to every 100 mL PBS solution to make PBS-T); bovine serum albumin (BSA) or calf serum (10%); 0.05 mol/L (pH 9.6) carbonate buffer, pH 5.0 phosphate-citrate buffer;
o-phenylenediamine (OPD),
30% hydrogen peroxide;
horse radish peroxidase-labeled horse anti-human IgE, k.,,2 mol/L sulfuric acid.
C4 Method
Coat with HSA, 37℃, 2h.
C4.2 Wash 3 times with PBS-T.
C4.3 Add allergen and incubate at 4℃ overnight.
C4.4 Wash 3 times with PBS-T.
C4.5 Add serum to be tested (the diluent is PBS-T, containing 1% BSA, 1:5 dilution) at 37℃, 90 min. C4. 6 Wash 6 times with PBS-T.
C4.7 Add enzyme-labeled antibody, 37℃, 90min. C4. 8 Wash 8 times with PBS-T.
C4.9 Add substrate solution 0.02% OPD, containing 1μL/10mL hydrogen peroxide, 37℃, 30min. C4. Terminate the reaction with 102 mol/L sulfuric acid.
OD value was measured by enzyme-linked immunosorbent assay with a wavelength of 492nm. Result judgment: 2SD greater than the normal mean was considered positive. C4.12
Appendix D
Allergen bronchial provocation test
(Supplement)
D1 Indoor allergen bronchial provocation test
D1.1 Preparation and basic conditions before the test
D1.1. 1 Performed during the asthma remission period (without symptoms). D1. 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. D1.1.3 Stop smoking and consuming irritating food and drinks within 6 hours before the test, and avoid excessive exercise. D1.1.4 The subjects have no upper respiratory tract infection recently. D1.1.5 Prepare safe first aid measures, such as oxygen, medicines, etc. D1.2 Method
This test method has not yet been standardized in China, so at least the following principles should be followed in practice: D1.2.1 Choose a suitable and effective bronchial provocation test method. Commonly used methods are: Devilbiss646 nebulizer, take 5 deep breaths at the functional residual position, and release a quantitative aerosol 0.6s after each inhalation. a.
Use Wrights' nebulizer for tidal breathing for 2min; 301
GB16377--1996
The airway allergy meter (Astograph) produced in Japan directly measures airway responsiveness. c.
In addition to the above three methods, other methods and nebulizers that meet the requirements and devices that can determine the amount of atomization can also be used for testing. The diameter of the aerosol particles produced by the nebulizer should be less than 5um on average. D1.2.2 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 a bronchial reaction. The presence of a 3mm pelvic mound (+) in the prick test, or 200 protein nitrogen units/mL, or an antigen concentration of 10~5～10- (W/V) can all 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. D1.2.3 Before the test, the lung function index (FEV1..) is measured 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 inhalation 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. D1.2.4 Forced vital capacity in the first second (FEV1..) can be used as a measurement indicator for 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 hour of inhalation. D1.2.5 In addition to paying attention to the reaction within 2 hours (mostly 10 to 30 minutes) after inhalation of allergens, attention should also be paid to the delayed or bidirectional reaction that occurs within 4 to 6 hours. Therefore, the total observation time should be up to 24 hours. D1. 3 Positive reaction standard
D1.3.1 FEV1.. decreases by more than 15% compared with before inhalation of antigen. The calculation method is: FEV1.. before provocation value - FEV1.. after provocation value - FEV1.. before provocation value
D1.3.2 If obvious symptoms and signs appear after stimulation, such as chest tightness, shortness of breath, severe cough, lung wheezing, etc., the upper value should be relaxed and (above 10%) is judged as positive.
D1.4 Precautions
a. The concentration of allergen inhalation should not be too high to avoid irritation; b. For some strong allergens (such as penicillin, etc.) or patients with a history of high sensitivity (such as anaphylactic shock) and other obvious systemic diseases, it is not appropriate to conduct the test;
C. Patients with extremely poor cardiopulmonary function and FEV1.<1 L should not conduct this test. In view of the fact that this test requires certain equipment and technical conditions, and individual cases may have overreactions during the test, d.
This test should be conducted in a hospital with conditions, e. It is not appropriate to give hints before or during the test, and the spirit should not be too nervous. D2 Occupational (on-site) bronchial provocation test D2.1 Preparation and basic conditions before the test
Same as D1.1.
D2.2 Method
D2.2.1 Within the first hour after entering the work site, measure the ventilation function (FEVi.) every 15 minutes. In the second hour, measure the ventilation function every half an hour. Depending on the situation, you can stay on the site for 1 to 2 hours. D2.2.2 After leaving contact, measure lung function once every hour, and pay attention to and record clinical symptoms and signs. Continuous observation for at least 8 hours, and another measurement should be made after 24 hours.
D2.2.3 If the lung function index decreases significantly and there are respiratory symptoms and signs, the provocation test can be terminated, that is, bronchodilator drugs such as salbutamol spray can be used for inhalation, and the recovery of lung function indexes can be observed. D2.3 Positive reaction standard
Same as D1.3.
D2.4 Precautions
Same as D1.4.
GB16377—1996
Appendix E
Instructions for the correct use of the standard
(reference)
E1 Scope of application of this standard: Limited to personnel who are directly exposed to the following occupational allergens (occupational allergens): Isocyanates: toluene diisocyanate (TDI), diphenylmethylene diisocyanate (MDI), hexamethylene diisocyanate (HDI), 8
naphthalene diisocyanate (NDI), etc.:
Phthalic anhydride: phthalic anhydride (PA), 1,2,4-trimethylbenzene anhydride (TMA), tetrachlorophthalic anhydride (TCPA), etc.; b.
Polyamine curing agent: ethylenediamine, diethylenetriamine, triethylenetetramine, etc., platinum complex salt
sisal.
E2 Accurate occupational history and medical history refer to:
Exposure to occupational asthma-causing substances (occupational allergens) within the above range at work; a.
No asthma before engaging in the job;
Developed paroxysmal or reversible asthma with lung wheezing after engaging in the job; there is reliable evidence to prove that asthma attacks are closely related to the occupation, that is, asthma occurred after exposure, while the symptoms improved or disappeared during holidays, and may relapse after further exposure;
Blockers of rapid-onset allergic reaction mediators, antihistamines and glucocorticoids have preventive and therapeutic effects; e.
The length of service is generally more than half a year.
E3 Abnormalities in specific laboratory indicators are currently limited to:
positive,
occupational (on-site) bronchial provocation test positive; indoor allergen bronchial provocation test positive, antigen-specific IgE antibody test (radioallergen adsorption test--RAST or enzyme-linked immunosorbent test--ELIST) allergen skin test (intradermal, prick or scratch method) repeated positive. E4 When diagnosing this disease, it should be differentiated from upper respiratory tract infection, chronic respiratory bronchitis, cardiac asthma, extrinsic allergic alveolitis and non-occupational bronchial asthma. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Hospital of Beijing Medical University and was jointly drafted by the Institute of Labor Health and Occupational Diseases, Chinese Academy of Preventive Medicine, the Second Affiliated Hospital of Shanxi Medical College, Guangdong Occupational Disease Hospital, Heilongjiang Provincial Institute of Labor Health and Occupational Disease Prevention and Control, and Guizhou Provincial Institute of Labor Health and Occupational Disease Prevention and Control.
This standard is interpreted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, which is the technical authority entrusted by the Ministry of Health.
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