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GBZ 57-2019 English PDF (GBZ57-2019)
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GBZ 57-2019: Diagnosis of occupational asthma
GBZ 57-2019
GBZ
NATIONAL OCCUPATIONAL HEALTH STANDARD
OF THE PEOPLE’S REPUBLIC OF CHINA
ICS 13.100
C 60
Replacing GBZ 57-2008
Diagnosis of occupational asthma
ISSUED ON: JANUARY 30, 2019
IMPLEMENTED ON: JULY 01, 2019
Issued by: National Health Commission of the PRC
Table of Contents
Foreword ... 3
1 Scope ... 5
2 Normative references ... 5
3 Terms and definitions ... 5
4 Diagnostic principles ... 6
5 Diagnosis ... 6
6 Treatment principles ... 7
7 Instructions for the correct use of this Standard ... 8
8 Laboratory sensitizer bronchial provocation test and job-site bronchial
provocation test ... 8
9 Sensitizer-specific IgE antibody detection-enzyme-linked immunosorbent
assay (ELISA) ... 8
10 Specific sensitizer skin test ... 8
Appendix A (Informative) Instructions for the correct use of this Standard ... 9
Appendix B (Normative) Laboratory sensitizer bronchial provocation test and
job-site bronchial provocation test ... 13
Appendix C (Informative) Sensitizer-specific IgE antibody detection-enzyme-
linked immunosorbent assay (ELISA) ... 17
Appendix D (Informative) Specific sensitizer skin test ... 20
Foreword
Clause 5 of this Standard is mandatory. The rest are recommended.
According to the Code of Occupational Disease Prevention of PRC, this
Standard is developed.
This Standard is drafted in accordance with the rules given in GB/T 1.1-2009.
This Standard replaces GBZ 57-2008 “Diagnostic criteria of occupational
asthma”.
As compared with GBZ 57-2008, the main changes are as follows:
- ADD terms and definitions;
- Expand the definition of occupational asthma and ADD reactive airway
dysfunction syndrome;
- REVISE the diagnostic principles;
- REVISE the diagnosis of occupational asthma and delete the grading;
- REVISE part of Appendix A;
- The index of Fractional exhaled nitric oxide is added to the positive reaction
standards of job-site bronchial provocation test;
- Delete appendixes “non-specific bronchial provocation test”, “exercise
challenge test”, and “sensitizer-specific IgE antibody detection-enzyme-
labelled fluorescence immunoassay (FEIA)”.
Drafting organizations of this Standard: Shanghai Pulmonary Hospital, Tongji
University (Shanghai Occupational Disease Prevention and Treatment
Hospital), Guangdong Province Hospital for Occupational Disease Prevention
and Treatment, The Second Hospital of Heilongjiang Province, West China
Fourth Hospital, Sichuan University.
Main drafters of this Standard: Zhang Jingbo, Sun Daoyuan, Chen Jiabin, Zhao
Liqiang, Song Li, Yang Huimin, Hu Yinghua.
The previous editions of this Standard were released as follows:
- GB 16377-1996;
- GBZ 57-2002;
Diagnosis of occupational asthma
1 Scope
This Standard specifies the principles of diagnosis and treatment of
occupational asthma.
This Standard applies to the diagnosis and treatment of occupational asthma.
2 Normative references
The following documents are indispensable for the application of this document.
For the dated references, only the editions with the dates indicated are
applicable to this document. For the undated references, the latest edition
(including all the amendments) are applicable to this document.
GB/T 16180 Standard for identify work ability - Gradation of disability caused
by work-related injuries and occupational diseases
3 Terms and definitions
The following terms and definitions apply to this document.
3.1 Occupational asthma
Chronic inflammatory disease of the airway involving a variety of cells including
eosinophils, mast cells, T lymphocytes, neutrophils, smooth muscle cells,
airway epithelial cells, and other cellular components, which is caused by
contact with certain chemical substances in occupational activities. It is
accompanied by variable airflow limitation and airway hyperresponsiveness.
Occupational asthma in this Standard includes occupational sensitizer-induced
asthma and occupational reactive airway dysfunction syndrome.
3.2 Occupational sensitizer-induced asthma
Chronic inflammatory disease of the airway characterized by intermittent attack
of wheezing, shortness of breath, chest tightness, or cough, etc. caused by
inhalation of sensitizers in occupational activities, with a period of incubation.
3.3 Occupational reactive airway dysfunction syndrome
Chronic airway neurogenic inflammatory disease with cough, wheezing, and
5.1.7 If 5.1.1+5.1.2+5.1.3 or 5.1.2+5.1.3+5.1.4 or 5.1.1+5.1.2+5.1.5 or
5.1.1+5.1.2+5.1.6 are met, occupational sensitizer-induced asthma can be
diagnosed.
5.2 Occupational reactive airway dysfunction syndrome
The following conditions shall be met at the same time:
a) There is an exact occupational inhalation history of large doses of irritant
chemicals in a short period of time;
b) After contact, mucosal irritation symptoms such as shedding tears,
pharyngalgia, cough, etc. appear immediately;
c) Within 24 h after inhalation, bronchial asthma symptoms appear. The
duration of the symptoms is longer than 3 months;
d) Pulmonary function test shows reversible obstructive ventilation function
disturbance or non-specific airway hyperresponsiveness;
e) There is no history of diseases of respiratory system such as chronic
bronchitis and chronic obstructive pulmonary disease.
6 Treatment principles
6.1 Therapeutic principles
6.1.1 After the diagnosis of occupational asthma is established, the patient shall
be removed from the original occupational activity environment as soon as
possible, to avoid and prevent the relapse of asthma.
6.1.2 Patients with acute asthma attacks shall be relieved for symptoms as soon
as possible, relieved for airflow limitation and hypoxemia. The main
pharmacotherapy methods are repeated inhalation of fast-acting β2 receptor
agonists, oral or intravenous glucocorticoids, inhalation of anticholinergic drugs,
and intravenous aminophylline, etc. Patients with severe asthma attacks and
acute respiratory failure, if necessary, shall be treated with mechanical
ventilation.
6.1.3 For long-term therapy of asthma, according to the severity of the disease,
an appropriate therapeutic regimen shall be selected. The goal is to achieve
and maintain symptom control, maintain normal activity level, and maintain
normal pulmonary function as much as possible.
6.2 Other treatment
Appendix A
(Informative)
Instructions for the correct use of this Standard
A.1 Occupational sensitizer or irritant chemical is one of the pathogenic factors
of bronchial asthma. Compared with common asthma, occupational sensitizer-
induced asthma has no difference in pathological changes, clinical
manifestations, pulmonary function changes, therapy, etc. The pathogenesis is
mainly sensitizer-induced mechanism, but other mechanisms are often mixed.
Respiratory inhalation is the main contact route for occupational sensitizer-
induced asthma and the starting position for stimulating the immune response.
A.2 Case data show that individual chemicals can, through skin contact, cause
occupational sensitizer-induced asthma, such as occupational sensitizer-
induced asthma caused by skin contact with latex. If epidemiological
investigations, toxicological studies indicate that other chemicals can also
cause sensitizer-induced asthma by skin contact, occupational asthma can be
diagnosed.
A.3 Case data show that occupational sensitizer-induced asthma often occurs
...
Get QUOTATION in 1-minute: Click GBZ 57-2019
Historical versions: GBZ 57-2019
Preview True-PDF (Reload/Scroll if blank)
GBZ 57-2019: Diagnosis of occupational asthma
GBZ 57-2019
GBZ
NATIONAL OCCUPATIONAL HEALTH STANDARD
OF THE PEOPLE’S REPUBLIC OF CHINA
ICS 13.100
C 60
Replacing GBZ 57-2008
Diagnosis of occupational asthma
ISSUED ON: JANUARY 30, 2019
IMPLEMENTED ON: JULY 01, 2019
Issued by: National Health Commission of the PRC
Table of Contents
Foreword ... 3
1 Scope ... 5
2 Normative references ... 5
3 Terms and definitions ... 5
4 Diagnostic principles ... 6
5 Diagnosis ... 6
6 Treatment principles ... 7
7 Instructions for the correct use of this Standard ... 8
8 Laboratory sensitizer bronchial provocation test and job-site bronchial
provocation test ... 8
9 Sensitizer-specific IgE antibody detection-enzyme-linked immunosorbent
assay (ELISA) ... 8
10 Specific sensitizer skin test ... 8
Appendix A (Informative) Instructions for the correct use of this Standard ... 9
Appendix B (Normative) Laboratory sensitizer bronchial provocation test and
job-site bronchial provocation test ... 13
Appendix C (Informative) Sensitizer-specific IgE antibody detection-enzyme-
linked immunosorbent assay (ELISA) ... 17
Appendix D (Informative) Specific sensitizer skin test ... 20
Foreword
Clause 5 of this Standard is mandatory. The rest are recommended.
According to the Code of Occupational Disease Prevention of PRC, this
Standard is developed.
This Standard is drafted in accordance with the rules given in GB/T 1.1-2009.
This Standard replaces GBZ 57-2008 “Diagnostic criteria of occupational
asthma”.
As compared with GBZ 57-2008, the main changes are as follows:
- ADD terms and definitions;
- Expand the definition of occupational asthma and ADD reactive airway
dysfunction syndrome;
- REVISE the diagnostic principles;
- REVISE the diagnosis of occupational asthma and delete the grading;
- REVISE part of Appendix A;
- The index of Fractional exhaled nitric oxide is added to the positive reaction
standards of job-site bronchial provocation test;
- Delete appendixes “non-specific bronchial provocation test”, “exercise
challenge test”, and “sensitizer-specific IgE antibody detection-enzyme-
labelled fluorescence immunoassay (FEIA)”.
Drafting organizations of this Standard: Shanghai Pulmonary Hospital, Tongji
University (Shanghai Occupational Disease Prevention and Treatment
Hospital), Guangdong Province Hospital for Occupational Disease Prevention
and Treatment, The Second Hospital of Heilongjiang Province, West China
Fourth Hospital, Sichuan University.
Main drafters of this Standard: Zhang Jingbo, Sun Daoyuan, Chen Jiabin, Zhao
Liqiang, Song Li, Yang Huimin, Hu Yinghua.
The previous editions of this Standard were released as follows:
- GB 16377-1996;
- GBZ 57-2002;
Diagnosis of occupational asthma
1 Scope
This Standard specifies the principles of diagnosis and treatment of
occupational asthma.
This Standard applies to the diagnosis and treatment of occupational asthma.
2 Normative references
The following documents are indispensable for the application of this document.
For the dated references, only the editions with the dates indicated are
applicable to this document. For the undated references, the latest edition
(including all the amendments) are applicable to this document.
GB/T 16180 Standard for identify work ability - Gradation of disability caused
by work-related injuries and occupational diseases
3 Terms and definitions
The following terms and definitions apply to this document.
3.1 Occupational asthma
Chronic inflammatory disease of the airway involving a variety of cells including
eosinophils, mast cells, T lymphocytes, neutrophils, smooth muscle cells,
airway epithelial cells, and other cellular components, which is caused by
contact with certain chemical substances in occupational activities. It is
accompanied by variable airflow limitation and airway hyperresponsiveness.
Occupational asthma in this Standard includes occupational sensitizer-induced
asthma and occupational reactive airway dysfunction syndrome.
3.2 Occupational sensitizer-induced asthma
Chronic inflammatory disease of the airway characterized by intermittent attack
of wheezing, shortness of breath, chest tightness, or cough, etc. caused by
inhalation of sensitizers in occupational activities, with a period of incubation.
3.3 Occupational reactive airway dysfunction syndrome
Chronic airway neurogenic inflammatory disease with cough, wheezing, and
5.1.7 If 5.1.1+5.1.2+5.1.3 or 5.1.2+5.1.3+5.1.4 or 5.1.1+5.1.2+5.1.5 or
5.1.1+5.1.2+5.1.6 are met, occupational sensitizer-induced asthma can be
diagnosed.
5.2 Occupational reactive airway dysfunction syndrome
The following conditions shall be met at the same time:
a) There is an exact occupational inhalation history of large doses of irritant
chemicals in a short period of time;
b) After contact, mucosal irritation symptoms such as shedding tears,
pharyngalgia, cough, etc. appear immediately;
c) Within 24 h after inhalation, bronchial asthma symptoms appear. The
duration of the symptoms is longer than 3 months;
d) Pulmonary function test shows reversible obstructive ventilation function
disturbance or non-specific airway hyperresponsiveness;
e) There is no history of diseases of respiratory system such as chronic
bronchitis and chronic obstructive pulmonary disease.
6 Treatment principles
6.1 Therapeutic principles
6.1.1 After the diagnosis of occupational asthma is established, the patient shall
be removed from the original occupational activity environment as soon as
possible, to avoid and prevent the relapse of asthma.
6.1.2 Patients with acute asthma attacks shall be relieved for symptoms as soon
as possible, relieved for airflow limitation and hypoxemia. The main
pharmacotherapy methods are repeated inhalation of fast-acting β2 receptor
agonists, oral or intravenous glucocorticoids, inhalation of anticholinergic drugs,
and intravenous aminophylline, etc. Patients with severe asthma attacks and
acute respiratory failure, if necessary, shall be treated with mechanical
ventilation.
6.1.3 For long-term therapy of asthma, according to the severity of the disease,
an appropriate therapeutic regimen shall be selected. The goal is to achieve
and maintain symptom control, maintain normal activity level, and maintain
normal pulmonary function as much as possible.
6.2 Other treatment
Appendix A
(Informative)
Instructions for the correct use of this Standard
A.1 Occupational sensitizer or irritant chemical is one of the pathogenic factors
of bronchial asthma. Compared with common asthma, occupational sensitizer-
induced asthma has no difference in pathological changes, clinical
manifestations, pulmonary function changes, therapy, etc. The pathogenesis is
mainly sensitizer-induced mechanism, but other mechanisms are often mixed.
Respiratory inhalation is the main contact route for occupational sensitizer-
induced asthma and the starting position for stimulating the immune response.
A.2 Case data show that individual chemicals can, through skin contact, cause
occupational sensitizer-induced asthma, such as occupational sensitizer-
induced asthma caused by skin contact with latex. If epidemiological
investigations, toxicological studies indicate that other chemicals can also
cause sensitizer-induced asthma by skin contact, occupational asthma can be
diagnosed.
A.3 Case data show that occupational sensitizer-induced asthma often occurs
...
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