消防人员的哮喘诊断性试验
2007/08/01
鉴于目前针对于某种特定职业性哮喘的研究,比如消防职业相关的哮喘还是很少，以致无法满足医疗需求，David Miedinger等对瑞士巴塞尔的101个消防人员进行了一项前瞻性研究，以评价呼吸道症状和检查结果对哮喘的诊断价值。研究项目包括对其进行问卷调查、肺活量测定、直接和间接的气道激发试验，呼出NO水平，皮肤点刺试验等。有呼吸道症状及气道高反应者定为哮喘。
研究结果显示有喘鸣是诊断哮喘最敏感的症状（敏感性78%，特异性93%）。而其它症状相比喘鸣来说，特异性高，但敏感性却显著降低。用甘露醇诱导支气管激发试验对哮喘诊断的敏感性（92%）和特异性（97%）最佳。NO值诊断的特异性和直接（乙酰甲胆碱）或间接（甘露醇）气道激发试验相似(96%)，但敏感性较低(42%)。该研究也指出，消防人员中许多哮喘患者未被诊断，应该得到重视。使用问卷调查，将主观症状和支气管激发试验联合可用于初筛哮喘患者，并应常规使用。
研究结果显示有喘鸣是诊断哮喘最敏感的症状（敏感性78%，特异性93%）。而其它症状相比喘鸣来说，特异性高，但敏感性却显著降低。用甘露醇诱导支气管激发试验对哮喘诊断的敏感性（92%）和特异性（97%）最佳。NO值诊断的特异性和直接（乙酰甲胆碱）或间接（甘露醇）气道激发试验相似(96%)，但敏感性较低(42%)。该研究也指出，消防人员中许多哮喘患者未被诊断，应该得到重视。使用问卷调查，将主观症状和支气管激发试验联合可用于初筛哮喘患者，并应常规使用。
（于娜 沈阳,中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2007; 131:1760-1767)
Diagnostic Tests for Asthma in Firefighters*
David Miedinger, MD; Prashant N. Chhajed, MD, FCCP; Michael Tamm, MD; Daiana Stolz, MD; Christian Surber, PhD and J?rg D. Leuppi, MD, PhD
David Miedinger, MD; Prashant N. Chhajed, MD, FCCP; Michael Tamm, MD; Daiana Stolz, MD; Christian Surber, PhD and J?rg D. Leuppi, MD, PhD
Abstract 摘要
Background: Subjects with asthma do not meet medical requirements for professions such as firefighting.
Objective: To prospectively determine the diagnostic value of respiratory symptoms and various tests used in the assessment of asthma in a cohort of firefighters.
Methods: A questionnaire, spirometry, direct and indirect airway challenge tests, exhaled nitric oxide, and skin-prick tests were administered prospectively to 101 of 107 firefighters employed in Basel, Switzerland. Asthma was defined as the combination of respiratory symptoms with airway hyperresponsiveness.
Results: Six of 101 firefighters (6%) had physician-diagnosed asthma, which could be confirmed in 4 firefighters. In contrast, asthma was diagnosed in 14% (14 of 101 firefighters). Wheezing was the most sensitive symptom for the diagnosis of asthma (sensitivity, 78%; specificity, 93%). Other respiratory symptoms showed a higher specificity than wheezing but a markedly lower sensitivity. Bronchial airway challenge with mannitol was the most sensitive (92%) and specific (97%) diagnostic test for asthma. Using a cutoff point of 47 parts per billion, nitric oxide had a similar specificity (96%) but lower sensitivity (42%) compared to the direct (methacholine) and indirect (mannitol) airway challenge tests.
Conclusion: Asthma was considerably underdiagnosed in firefighters. The combination of a structured symptom questionnaire with a bronchial challenge test allows to identify patients with asthma and should routinely be used in the assessment of active firefighters and may be of help when evaluating candidates for this profession.
Key Words: asthma test·exhaled nitric oxide· firefighters ·mannitol·methacholine·skin prick test
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不同严重程度哮喘患者呼出一氧化氮的差流分析（Differential Flow Analysis）
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5～6岁过敏儿童对气道过敏原激发试验反应的预测因素
