Overdiagnosis of asthma in obese and nonobese adults
Overdiagnosis of asthma in obese and nonobese adults
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DOI：
10.1503/cmaj.081332
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发表时间：
2008-11-18
影响因子：
14.6
通讯作者：
Fergusson, Dean
中科院分区：
文献类型：
--
作者：
Aaron, Shawn D.;Vandemheen, Katherine L.;Fergusson, Dean
背景资料：目前尚不清楚发达国家是否存在哮喘过度诊断，特别是肥胖人群，他们可能比非肥胖人群更容易发生呼吸困难。方法：我们进行了一项纵向研究，涉及非肥胖（体重指数20-25）和肥胖（体重指数>= 30）的哮喘患者，这些患者均由医生诊断。参与者通过随机数字拨号从加拿大8个城市招募。在那些没有哮喘症状急性恶化、可逆性气流阻塞或支气管高反应性证据的患者中，排除了当前哮喘的诊断，尽管他们已经停用了哮喘药物。我们停止哮喘药物治疗，在那些诊断哮喘被排除在外，并评估他们的临床outcomes over 6 months.Results：540个人与医生诊断的哮喘谁参加了这项研究，496（242肥胖和254 nonobese）可以最终评估哮喘的诊断。肥胖组最终排除哮喘的比例为31.8%（95%置信区间[CI] 26.3%-37.9%），非肥胖组为28.7%（95% CI 23.5%-34.6%）。过度诊断哮喘在肥胖者中并不比在非肥胖者中更容易发生（p = 0.46）。在排除哮喘的患者中，有65.5%的患者在6个月的随访期内没有因为哮喘症状而需要服用哮喘药物或寻求医疗服务。解释：在医生诊断为哮喘的肥胖和非肥胖患者中，约有三分之一的人在客观评估时没有哮喘。这一发现表明，在加拿大等发达国家，哮喘被过度诊断。
Background: It is unclear whether asthma is overdiagnosed in developed countries, particularly among obese individuals, who may be more likely than nonobese people to experience dyspnea.Methods: We conducted a longitudinal study involving nonobese (body mass index 20-25) and obese (body mass index >= 30) individuals with asthma that had been diagnosed by a physician. Participants were recruited from 8 Canadian cities by means of random-digit dialing. A diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms, reversible airflow obstruction or bronchial hyperresponsiveness, despite being weaned off asthma medications. We stopped asthma medications in those in whom a diagnosis of asthma was excluded and assessed their clinical outcomes over 6 months.Results: Of 540 individuals with physician-diagnosed asthma who participated in the study, 496 (242 obese and 254 nonobese) could be conclusively assessed for a diagnosis of asthma. Asthma was ultimately excluded in 31.8% (95% confidence interval [CI] 26.3%-37.9%) in the obese group and in 28.7% ( 95% CI 23.5%-34.6%) in the nonobese group. Overdiagnosis of asthma was no more likely to occur among obese individuals than among nonobese individuals (p = 0.46). Of those in whom asthma was excluded, 65.5% did not need to take asthma medication or seek health care services because of asthma symptoms during a 6-month follow-up period.Interpretation: About one-third of obese and nonobese individuals with physician-diagnosed asthma did not have asthma when objectively assessed. This finding suggests that, in developed countries such as Canada, asthma is overdiagnosed.