FEV1速效支气管扩张反应作为成人哮喘的诊断标准

2018/12/17

   摘要
   背景:哮喘以可变和可逆的呼气气流受限为特征。因此,使用支气管扩张剂后FEV1的变化(ΔFEV1BDR)即基线FEV1增加≥12%和≥200mL作为诊断工具是合理的。本文旨在评估成人ΔFEV1BDR诊断临界水平的历史发展以及这些建议背后的证据。
   方法:我们从所有关于哮喘的肺活量测定和诊断解释的主要陈述,报告和指南的参考列表中搜索研究,并进行了文献检索。
   结果:我们发现了有关健康人群中ΔFEV1BDR的有限数量的证据,并且发现了更少的患者研究。在健康人中,95%的ΔFEV1BDR绝对值变化在240和320ml之间,从初始FEV1计算的相对ΔFEV1BDR改变5.9-13.3%,根据预计FEV1计算的ΔFEV1BDR变化范围为8.7-11.6%。然而,绝对值和从初始FEV1计算的ΔFEV1BDR百分值取决于年龄,性别,身高和气道阻塞程度。因此,使用根据预计FEV1计算的ΔFEV1BDR可能更合适。
   结论:评估区分哮喘患者和健康受试者的ΔFEV1BDR的任何临界水平的敏感性没有足够的数据。需要对新诊断的哮喘患者进行进一步研究。


 
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Eur Respir J. 2018 Nov 21. pii: 1800904. doi: 10.1183/13993003.00904-2018. [Epub ahead of print])


 
 
 
Immediate bronchodilator response in FEV1 as a diagnostic criterion for adult asthma.
 
Tuomisto LE, Ilmarinen P, Lehtimäki L, Tommola M, Kankaanranta H.
 
Abstract
BACKGROUND:Asthma is characterised by variable and reversible expiratory airflow limitations. Thus, it is logical to use the change in FEV1 in response to a bronchodilator (ΔFEV1BDR) as a diagnostic tool; increases of ≥12% and ≥200 mL from the baseline FEV1 are commonly used values. To evaluate the historical development of diagnostic cut-off levels for the ΔFEV1BDR for adults and the evidence behind these recommendations.
METHODS:We searched for studies from the reference lists of all the main statements, reports and guidelines concerning the interpretation of spirometry and diagnostics for asthma and conducted a literature search.
RESULTS:A limited amount of evidence regarding the ΔFEV1BDR in healthy populations was found, and even fewer patient studies were found. In healthy persons, the upper 95th percentile for the absolute ΔFEV1BDR ranges between 240 and 320 mL, for the relative ΔFEV1BDR calculated from the initial FEV1 ranges from 5.9-13.3%, and for the ΔFEV1BDR calculated from the predicted FEV1 ranges from 8.7-11.6%. However, the absolute and percentage ΔFEV1BDR values calculated from the initial FEV1 are dependent on age, sex, height and the degree of airway obstruction. Thus, the use of the ΔFEV1BDR calculated from the predicted FEV1 might be more appropriate.
CONCLUSIONS:Not enough data exist to assess the sensitivity of any of the cut-off levels for the ΔFEV1BDR to differentiate asthma patients from healthy subjects. Further studies in newly diagnosed asthma patients are needed.




上一篇: 持续性儿童哮喘的缓解:成人结局的早期预测因子
下一篇: 一项试验性随机对照试验,比较基于短信收发和网络哮喘行动计划与书面行动计划对哮喘恶化的影响

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