肥胖与非肥胖哮喘患者之比较：探索哮喘¬肥胖的交互关系
2010/12/07
目的：我们研究的目的是，比较肥胖哮喘患者和正常体重哮喘患者的临床特征和病情严重程度，并探索哮喘误诊的原因，包括与肥胖潜有的交互作用。
方法：我们从加拿大的8个城市随机选择被医师诊断为哮喘的患者。哮喘的确诊经连续的肺功能检测程序而确定。采用Logistic分析比较肥胖和正常体重的哮喘患者，评价与哮喘误诊有关的特征。并观察与肥胖的交互作用。
结果：496例经医师诊断的哮喘患者（其中242例肥胖和 254正常体重者)获得了完整的评价。其中有346例经连续肺功能测定确诊为哮喘，150例的哮喘诊断被排除。与正常体重的哮喘患者比较，肥胖哮喘患者更有可能是男性，罹患高血压和胃食管返流病的病史和较低的第1秒用力呼气容积（FEV1）值。年龄偏大、男性和较高的FEV1患者更有可能误诊为哮喘。虽然肥胖不是哮喘误诊的独立预测指标，但是肥胖和因呼吸症状需要急诊之间存在交互作用。与正常体重患者比较，获得哮喘误诊的肥胖患者在过去的12个月因呼吸症状需要急诊的机会比（OR）是4.08（95% 可信区间, 1.23-13.5)。
结论：与正常体重的哮喘患者比较，肥胖的哮喘患者有较低的肺功能和较多的合并症。因呼吸症状需急诊的肥胖患者更有可能被误诊为哮喘。
（王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译）
(Chest. 2010; 137(6):1316–1323)
A comparison of obese and nonobese people with asthma: exploring an asthma-obesity interaction
Pakhale S, Doucette S, Vandemheen K, Boulet LP, McIvor RA, FitzGerald JM, Hernandez P, Lemiere C, Sharma S, Field SK, Alvarez GG, E. Dales RE, Aaron SD.
Chest. 2010; 137(6):1316–1323
Objective: The objectives of our study were to compare patient characteristics and severity ofdisease in obese and normal-weight-confi rmed people with asthma and to explore reasons formisdiagnosis of asthma, including potential interactions with obesity.
Methods: We randomly selected patients with physician-diagnosed asthma from eight Canadiancities. Asthma diagnosis was confi rmed via a sequential lung function testing algorithm. Logisticanalysis was conducted to compare obese and normal-weight-confi rmed people with asthma andto assess characteristics associated with misdiagnosis of asthma. Interaction with obesity wasinvestigated.
Results: Complete assessments were obtained on 496 subjects who reported physician-diagnosedasthma (242 obese and 254 normal-weight subjects); 346 had asthma confi rmed with sequentiallung testing, and in 150 subjects a diagnosis of asthma was ruled out. Obese subjects with asthmawere signifi cantly more likely to be men, have a history of hypertension and gastroesophagealrefl ux disease, and have a lower FEV 1 compared with normal-weight subjects with asthma. Oldersubjects, men, and subjects with higher FEV 1 were more likely to have received misdiagnoses of
asthma. Obesity was not an independent predictor of misdiagnosis, however there was an interactionbetween obesity and urgent visits for respiratory symptoms. The odds ratio for receiving amisdiagnosis of asthma for obese individuals as compared with normal-weight individuals was4.08 (95% CI, 1.23-13.5) for those with urgent visits in the past 12 months.
Conclusions: Obese people with asthma have lower lung function and morecomorbidities comparedwith normal-weight people with asthma. Obese individuals who make urgent visits for respiratorysymptoms are more likely to receive a misdiagnosis of asthma.
CHEST 2010; 137(6):1316–1323
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重度难治性哮喘的呼出气一氧化氮与呼出气冷凝液pH值
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哮喘和慢性咳嗽患者诱导痰黏蛋白的浓度
