哮喘联盟

   摘要
   背景：过去几十年来，肥胖和哮喘的发病率同时呈逐渐上升趋势，提示肥胖和哮喘间存在相关性。但是在这些人群里哮喘可能没有得到充分诊断。
   目标：调查肥胖人群中是否不仅存在哮喘的过度诊断，还存在哮喘的诊断不足。
   方法：本研究通过一个减肥手术术前筛查项目，招募了伴或不伴被医师诊断为哮喘的病态肥胖患者，并采用一种广泛诊断流程区分其特点。
   结果：一共筛查了473例受试者，220例符合入组标准，86例同意参加研究。在32例医生诊断哮喘患者中，19例(59%, 95% CI [0.41-0.76])可检测到可逆性气道阻塞和/或支气管高反应性，13例(41%, 95% CI [0.24-0.50])患者的哮喘诊断不能确立（过度诊断）。相反，在剩下的54例患者中，17例(31%, 95% CI [0.20-0.46])被新诊断为哮喘（诊断不足）。
   结论：在病态肥胖患者中，除哮喘的过度诊断外还存在大量诊断不足的现象。症状可能被错误地归因为肥胖或哮喘，因此，对于病态肥胖患者的哮喘诊断也应基于肺功能检测结果。
 

（苏楠 审校）
RespirMed.2013Jun10.pii:S0954-6111(13)00181-9.doi:10.1016/j.rmed.2013.05.007. [Epub ahead of print]

 

Underdiagnosis and overdiagnosis of asthma in the morbidly obese.
 

van Huisstede A, Castro Cabezas M, van de Geijn GJ, Mannaerts G, Njo TL, Taube C, Hiemstra PS, Braunstahl GJ.
 

Abstract
BACKGROUND: The prevalence of obesity and asthma has increased concurrently over the last decades, suggesting a link between obesity and asthma. However, asthma might not be adequately diagnosed in this population.
AIM: To investigate whether not only overdiagnosis but also underdiagnosis of asthma is present in an obese population.
METHODS: Morbidly obese subjects with or without physician-diagnosed asthma were recruited from a pre-operative screening programme for bariatric surgery, and were characterized using an extensive diagnostic algorithm.
RESULTS: 473 subjects were screened; 220 met inclusion criteria, and 86 agreed to participate. Among the 32 participating subjects who had a physician diagnosis of asthma, reversible airway obstruction and/or bronchial hyperresponsiveness could only be detected in 19 patients (59%, 95% CI [0.41-0.76]), whereas in 13 patients (41%, 95% CI [0.24-0.50]) the diagnosis of asthma could not be confirmed (overdiagnosis). In contrast, in the remaining 54 patients, 17 (31%, 95% CI [0.20-0.46]) were newly diagnosed with asthma (underdiagnosis).
CONCLUSION: Besides overdiagnosis, there is also substantial underdiagnosis of asthma in the morbidly obese. Symptoms could be incorrectly ascribed to either obesity or asthma, and therefore also in the morbidly obese the diagnosis of asthma should also be based on pulmonary function testing.
 

RespirMed.2013Jun10.pii:S0954-6111(13)00181-9.doi:10.1016/j.rmed.2013.05.007. [Epub ahead of print]