哮喘诊断的第四维度
2021/02/09
摘要
哮喘是英国最常见的慢性呼吸道疾病，但其误诊率很高。国家指南缺乏一致性和诊断算法性能数据的缺乏，加剧了哮喘诊断的挑战。哮喘是一种高度节律性疾病，其特点是临床症状和发病机制存在昼夜差异。哮喘在不同日期、季节和年份都会有不同。尽管这是哮喘的一个标志，但这种变异性也对哮喘的诊断提出了重大挑战。几乎所有已建立的哮喘诊断工具都显示出昼夜变化，但很少有测量的标准化时间。使用固定的临界值对诊断结果进行二分法解释可能会进一步限制测试的准确性，特别是当一天内的昼夜变化跨越临界值时，需要仔细解释“阳性”和“阴性”结果之外的情况。日变化和更长期的变化是不可预测的，在无症状期进行哮喘诊断试验是否会影响诊断敏感性尚不清楚。随着哮喘诊断工具、家庭监测和数字应用程序的发展，需要新的策略来弥合这些认知差异，在标准化过程中应考虑昼夜变化。本文综述了哮喘昼夜节律的生物学机制，并着重介绍了时间（第四维度）在哮喘诊断中的意义。
Asthma diagnosis: into the fourth dimension.
Ran Wang, Clare S Murray, Stephen J Fowler, Angela Simpson, Hannah Jane Durrington.
Abstract
Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the 'positive' and 'negative' outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis.
哮喘是英国最常见的慢性呼吸道疾病，但其误诊率很高。国家指南缺乏一致性和诊断算法性能数据的缺乏，加剧了哮喘诊断的挑战。哮喘是一种高度节律性疾病，其特点是临床症状和发病机制存在昼夜差异。哮喘在不同日期、季节和年份都会有不同。尽管这是哮喘的一个标志，但这种变异性也对哮喘的诊断提出了重大挑战。几乎所有已建立的哮喘诊断工具都显示出昼夜变化，但很少有测量的标准化时间。使用固定的临界值对诊断结果进行二分法解释可能会进一步限制测试的准确性，特别是当一天内的昼夜变化跨越临界值时，需要仔细解释“阳性”和“阴性”结果之外的情况。日变化和更长期的变化是不可预测的，在无症状期进行哮喘诊断试验是否会影响诊断敏感性尚不清楚。随着哮喘诊断工具、家庭监测和数字应用程序的发展，需要新的策略来弥合这些认知差异，在标准化过程中应考虑昼夜变化。本文综述了哮喘昼夜节律的生物学机制，并着重介绍了时间（第四维度）在哮喘诊断中的意义。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Thorax. 2021 Jan 27;thoraxjnl-2020-216421. doi: 10.1136/thoraxjnl-2020-216421.)
(Thorax. 2021 Jan 27;thoraxjnl-2020-216421. doi: 10.1136/thoraxjnl-2020-216421.)
Asthma diagnosis: into the fourth dimension.
Ran Wang, Clare S Murray, Stephen J Fowler, Angela Simpson, Hannah Jane Durrington.
Abstract
Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the 'positive' and 'negative' outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis.
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肥大细胞源性的5-羟色胺增强乙酰甲胆碱诱导的屋尘螨诱发的实验性哮喘的气道高反应性
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上皮细胞的表达及其分泌的STC1通过钙通道调节对哮喘气道高反应性的作用
