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Vol. 33. Issue 9.
Pages 444-449 (October 1997)
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Vol. 33. Issue 9.
Pages 444-449 (October 1997)
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La prueba de provocación bronquial específica en el diagnóstico del asma ocupacional
Specific bronchial challenge test for diagnosing occupational asthma
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J. Fraj*, F. Duce, A. Lezaun, C. Colás, M.A. Domínguez, M.C. Abadía
Servicio de Alergia. Hospital Clínico Universitario Lozano Blesa. Zaragoza
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La prueba de provocación bronquial específica (PPBE) representa el método clave en el diagnóstico etiológico del asma ocupacional (AO). Sus indicaciones son precisas e incluyen casos en los que existen varios agentes en el ambiente laboral potencialmente causantes de AO, reconocimiento de agentes ocupacionales nuevos o poco frecuentes, existencia de litigio médico-legal y como herramienta de investigación. La metodología de la PPBE no está universalmente estandarizada debido a la gran heterogeneidad de los diferentes agentes ocupacionales y a sus diversas propiedades físicoquímicas. Así, los agentes que se encuentran en forma de humos, gases o vapores podrán ser utilizados en PPBE dentro de cabinas especiales, en circuitos cerrados y monitorización constante de las concentraciones subirritantes. Los agentes que se encuentran en forma de polvo, la mayoría de sustancias de elevado peso molecular y algunas de bajo peso molecular, pueden ser adecuados para PPBE de rutina en un laboratorio de alergia. Sólo estos casos serán referidos en este trabajo. La PPBE debe ser realizada en centros especializados y por personal experimentado al ser una técnica sofisticada y potencialmente peligrosa.

Presentamos una serie de 20 pacientes diagnosticados de AO en nuestro servicio en los últimos 2 años, sometidos a PPBE, gracias a la cual se obtuvo el diagnóstico etiológico. Todos estaban expuestos a material pulvígeno o aerosoles en su trabajo. En 17 casos el agente causal fue una sustancia de elevado peso molecular y en tres fueron sustancias de bajo peso molecular. Se describe la metodología llevada a cabo y se discuten los modelos de respuesta bronquial.

Palabras clave:
Asma ocupacional
Alergeno ocupacional
Alergia
Provocación bronquial

Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agentes present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and Chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique.

We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.

Key words:
Occupational asthma
Occupational allergen
Allergy
Specific bronchial challenge
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Copyright © 1997. Sociedad Española de Neumología y Cirugía Torácica
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