基于人群的病例发现以确诊未诊断为哮喘或COPD的患者
2020/05/14
摘要
背景：大约5-10％的成年人未确诊气流阻塞。该项研究的目的是发掘以人群为基础的病例发现方法，以评估在加拿大具有呼吸系统症状成人中未确诊气流阻塞（哮喘或COPD）的患病情况。
方法：以随机数位拨号的方式入组既往无哮喘、COPD或肺部疾病的成人，并询问他们在过去6个月内是否有呼吸困难、咳嗽、咳痰或喘息的症状。具有肯定回答的人填写哮喘筛查问卷（ASQ）、COPD诊断问卷（COPD-DQ）和COPD评估测试（CAT）。ASQ评分≥6或COPD-DQ评分≥20的患者进行支气管扩张剂使用之前及之后的肺功能测定，以确诊是否存在哮喘或COPD。
结果：与居家的12117例进行联系，同时评估其是否适合入组。在1260例合格人群中，有910例（72％）进行肺功能测定。最终，184例（占研究人群20％）患有阻塞性肺部疾病（73例哮喘和111例COPD）。与无气流阻塞的人群相比，发现未确诊哮喘或COPD的气流阻塞人群具有较重的呼吸道症状及较差生活质量。ASQ评分、COPD-DQ评分和CAT评分对未确诊的哮喘或COPD的ROC值分别为0.49、0.64及0.56。四个描述变量：年龄、BMI、性别及吸烟指数，较问卷调查ROC值更好（ROC=0.68）。
结论；在加拿大，随机选择的具有呼吸道症状的人群中20%未被确诊为气流阻塞。问卷调查可以排除低风险患者，但不能准确地找到未能确诊疾病的患者。
Population-Based Case-Finding to Identify Subjects with Undiagnosed
Asthma or COPD.
Preteroti M, Whitmore GA, Vandemheen KL, Mark FitzGerald J, Lemière C, Boulet LP, Penz E, Field SK, Gupta S, Andrew McIvor R, Mayers I, Hernandez P, Lougheed D, Ainslie M, Licskai C, Azher T, Fraser I, Mahdavian M, Aaron SD.
Abstract
BACKGROUND: Approximately 5-10% of adults may have undiagnosed airflow obstruction. The objective of this study was to develop a population-based case-finding strategy to assess the prevalence of undiagnosed airflow obstruction (asthma or COPD) amongst adults with respiratory symptoms in Canada.
METHODS: Adults without a previous history of asthma, COPD, or lung disease were recruited by random digit-dialling and asked if they had symptoms of dyspnea, cough, sputum or wheeze within the past 6 months. Those who answered affirmatively completed the Asthma Screening Questionnaire (ASQ), COPD-Diagnostic Questionnaire (COPD-DQ), and COPD Assessment Test (CAT). Those with ASQ score ≥6 or COPD-DQ score ≥20 underwent pre and post bronchodilator spirometry to diagnose asthma or COPD.
RESULTS:12 117 individuals were contacted at home and assessed for study eligibility. Of 1260 eligible individuals, 910 (72%) enrolled and underwent spirometry. Ultimately, 184 subjects (20% of those enrolled) had obstructive lung disease (73 asthma and 111 COPD). Individuals found to have undiagnosed asthma or COPD had more severe respiratory symptoms and impaired quality of life compared to those without airflow obstruction. The ASQ, COPD-DQ, and CAT had ROC areas for predicting undiagnosed asthma or COPD of 0.49, 0.64 and 0.56 respectively. Four descriptive variables; age, BMI, sex and pack-years smoked, produced better ROC values than the questionnaires (ROC area=0.68).
CONCLUSION:Twenty percent of randomly-selected individuals who report respiratory symptoms in Canada have undiagnosed airflow obstruction due to asthma or COPD. Questionnaires could exclude subjects at low risk but lacked ability to accurately find subjects with undiagnosed disease.
背景：大约5-10％的成年人未确诊气流阻塞。该项研究的目的是发掘以人群为基础的病例发现方法，以评估在加拿大具有呼吸系统症状成人中未确诊气流阻塞（哮喘或COPD）的患病情况。
方法：以随机数位拨号的方式入组既往无哮喘、COPD或肺部疾病的成人，并询问他们在过去6个月内是否有呼吸困难、咳嗽、咳痰或喘息的症状。具有肯定回答的人填写哮喘筛查问卷（ASQ）、COPD诊断问卷（COPD-DQ）和COPD评估测试（CAT）。ASQ评分≥6或COPD-DQ评分≥20的患者进行支气管扩张剂使用之前及之后的肺功能测定，以确诊是否存在哮喘或COPD。
结果：与居家的12117例进行联系，同时评估其是否适合入组。在1260例合格人群中，有910例（72％）进行肺功能测定。最终，184例（占研究人群20％）患有阻塞性肺部疾病（73例哮喘和111例COPD）。与无气流阻塞的人群相比，发现未确诊哮喘或COPD的气流阻塞人群具有较重的呼吸道症状及较差生活质量。ASQ评分、COPD-DQ评分和CAT评分对未确诊的哮喘或COPD的ROC值分别为0.49、0.64及0.56。四个描述变量：年龄、BMI、性别及吸烟指数，较问卷调查ROC值更好（ROC=0.68）。
结论；在加拿大，随机选择的具有呼吸道症状的人群中20%未被确诊为气流阻塞。问卷调查可以排除低风险患者，但不能准确地找到未能确诊疾病的患者。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Eur Respir J. 2020 Apr 16. pii: 2000024. doi: 10.1183/13993003.00024-2020. [Epub ahead of print]）
（Eur Respir J. 2020 Apr 16. pii: 2000024. doi: 10.1183/13993003.00024-2020. [Epub ahead of print]）
Population-Based Case-Finding to Identify Subjects with Undiagnosed
Asthma or COPD.
Preteroti M, Whitmore GA, Vandemheen KL, Mark FitzGerald J, Lemière C, Boulet LP, Penz E, Field SK, Gupta S, Andrew McIvor R, Mayers I, Hernandez P, Lougheed D, Ainslie M, Licskai C, Azher T, Fraser I, Mahdavian M, Aaron SD.
Abstract
BACKGROUND: Approximately 5-10% of adults may have undiagnosed airflow obstruction. The objective of this study was to develop a population-based case-finding strategy to assess the prevalence of undiagnosed airflow obstruction (asthma or COPD) amongst adults with respiratory symptoms in Canada.
METHODS: Adults without a previous history of asthma, COPD, or lung disease were recruited by random digit-dialling and asked if they had symptoms of dyspnea, cough, sputum or wheeze within the past 6 months. Those who answered affirmatively completed the Asthma Screening Questionnaire (ASQ), COPD-Diagnostic Questionnaire (COPD-DQ), and COPD Assessment Test (CAT). Those with ASQ score ≥6 or COPD-DQ score ≥20 underwent pre and post bronchodilator spirometry to diagnose asthma or COPD.
RESULTS:12 117 individuals were contacted at home and assessed for study eligibility. Of 1260 eligible individuals, 910 (72%) enrolled and underwent spirometry. Ultimately, 184 subjects (20% of those enrolled) had obstructive lung disease (73 asthma and 111 COPD). Individuals found to have undiagnosed asthma or COPD had more severe respiratory symptoms and impaired quality of life compared to those without airflow obstruction. The ASQ, COPD-DQ, and CAT had ROC areas for predicting undiagnosed asthma or COPD of 0.49, 0.64 and 0.56 respectively. Four descriptive variables; age, BMI, sex and pack-years smoked, produced better ROC values than the questionnaires (ROC area=0.68).
CONCLUSION:Twenty percent of randomly-selected individuals who report respiratory symptoms in Canada have undiagnosed airflow obstruction due to asthma or COPD. Questionnaires could exclude subjects at low risk but lacked ability to accurately find subjects with undiagnosed disease.
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