The American Thoracic Society's spirometric criteria alone is inadequate in asthma diagnosis.
The American Thoracic Society's spirometric criteria alone is inadequate in asthma diagnosis.
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DOI：
10.1155/2006/198940
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发表时间：
2006-11
影响因子：
2.2
通讯作者：
J. Gjevre;T. Hurst;R. Taylor-Gjevre;D. Cockcroft
中科院分区：
文献类型：
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作者：
J. Gjevre;T. Hurst;R. Taylor-Gjevre;D. Cockcroft
背景哮喘的诊断是基于临床症状、体格检查和肺功能测试，并且可能非常具有挑战性。大多数哮喘患者在肺量测定中有显著的支气管扩张后反应，表明气道高反应性。然而，具有显著的支气管扩张反应本身并不能诊断哮喘。对“重大”反应的定义也存在争议。许多呼吸科医生使用美国胸科学会（ATS）的支气管扩张剂后反应标准，即1 s内用力呼气量（或用力肺活量）较基线肺量测定法改善12%（前提是200 mL或更大）。方法在本研究中，对644例符合ATS标准的显著支气管扩张剂后肺功能反应的患者进行了回顾性分析。呼吸科医生基于所有临床和肺功能数据对哮喘的诊断被用作哮喘诊断的标准。结果仅依靠肺量测定标准来诊断哮喘是不够的，因为在310名符合ATS支气管扩张剂反应标准的患者中，只有54.7%被认为患有临床哮喘。增加支气管扩张剂后ATS标准的改善百分比仅略微改善诊断特异性，并导致灵敏度下降。结论：本研究的结果进一步强调了需要使用肺功能标准作为指导，而不是作为一个无可指责的金标准来诊断哮喘。哮喘的诊断取决于专家医生对患者病史、体检和肺功能检查结果的相关性。
BACKGROUND The diagnosis of asthma is based on clinical symptoms, physical examination and pulmonary function tests, and can be very challenging. Most patients with asthma have a significant postbronchodilator response on spirometry indicating airway hyperresponsiveness. However, having a significant bronchodilator response by itself is not diagnostic of asthma. The definition of a 'significant' response has also been controversial. Many respirologists use the American Thoracic Society (ATS) postbronchodilator response criteria of 12% (provided it is 200 mL or greater) improvement in forced expiratory volume in 1 s (or forced vital capacity) from the baseline spirometry. METHODS In the present study, 644 patients who met the ATS criteria for a significant postbronchodilator spirometric response were retrospectively reviewed. The staff respirologist's diagnosis of asthma, based on all clinical and pulmonary function data, was used as the standard for the diagnosis of asthma. RESULTS Relying on spirometric criteria alone was inadequate in asthma diagnosis because only 54.7% of 310 patients who met the ATS bronchodilator response criteria were thought to have clinical asthma. Increasing the postbronchodilator percentage improvement from the ATS criteria only marginally improved diagnostic specificity and resulted in a decline in sensitivity. CONCLUSIONS The results of the present study further emphasize the need to use spirometric criteria as a guide but not as an unimpeachable gold standard with which to make a diagnosis of asthma. The diagnosis of asthma depends on expert physician correlation of patient history, physical examination and pulmonary function test results.