哮喘联盟

   摘要
   背景：十年来，肥胖和哮喘的患病率同时增加，这提示着肥胖与哮喘之间存在关联。然而,哮喘在这一人群中可能未被正确的诊断。
   目的：研究在肥胖人群中，哮喘是否不仅仅被误诊而且被漏诊。
   方法：从之前肥胖手术的有效筛查项目中，纳入伴或不伴医生诊断的肥胖受试者，应用广泛的诊断流程进行特征记录。
   结果：筛选出473例受试者，220例符合纳入标准，86例参与研究。在32例被诊断哮喘的受试者中，只有19例(59%, 95% CI [0.41-0.76])检测到可逆性气道障碍和/或支气管高反应性，13例(41%, 95% CI [0.24-0.50])诊断的哮喘受试者没有被验证（误诊），相反分别有54例，17例(31%, 95% CI [0.20-0.46])被新诊断为哮喘（漏诊）。
   结论：除漏诊外，有大量肥胖被误诊为哮喘。症状可能被错误地判断为肥胖或哮喘，因此诊断哮喘的肥胖患者同样也应以肺功能检测为基础。

（苏楠 审校）
Respir Med. 2013 Sep;107(9):1356-64. doi: 10.1016/j.rmed.2013.05.007. Epub 2013 Jun 10.

 

Underdiagnosis and overdiagnosis of asthma in the morbidly obese.
 

van Huisstede A, Castro Cabezas M, van de Geijn GJ, Mannaerts GH, 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.
 

Respir Med. 2013 Sep;107(9):1356-64. doi: 10.1016/j.rmed.2013.05.007. Epub 2013 Jun 10.