Predictive value of respiratory symptoms for the diagnosis of pollen-induced seasonal asthma among children and adults in Inner Mongolia.
Predictive value of respiratory symptoms for the diagnosis of pollen-induced seasonal asthma among children and adults in Inner Mongolia.
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DOI：
10.2147/tcrm.s138355
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发表时间：
2017
影响因子：
2.8
通讯作者：
Shi HZ
中科院分区：
文献类型：
--
作者：
Ma TT;Zhuang Y;Gong HY;Yii AC;Wang XY;Shi HZ
哮喘的诊断是基于可变的呼吸道症状，并得到可变气流限制的客观证据的支持。然而，在资源稀缺的环境中或在大规模流行病学研究的背景下，肺功能测定和支气管激发试验可能无法常规使用。关于呼吸道症状对花粉诱发哮喘诊断的预测价值，目前还缺乏相关知识。本研究的目的是探讨自我报告的呼吸道症状诊断花粉诱发哮喘的预测价值。我们招募了2015年7月至9月花粉季节期间在内蒙古两家中心医院呼吸内科门诊就诊的1，161例呼吸道症状患者。所有患者均由呼吸科医生进行访谈，并完成问卷调查、肺功能检查和常见吸入性过敏原皮肤点刺试验。共有392名患者（33.8%）被诊断为哮喘，292名（25.2%，160名成人，132名儿童）被诊断为花粉诱发的哮喘。呼吸道症状如咳嗽、喘息、呼吸困难、胸痛和因呼吸困难引起的夜间觉醒都与被诊断为花粉诱导的哮喘的几率增加有关，咳嗽是成人和儿童最常见的症状，成人和儿童的敏感性分别为90.6%和88.6%。与其他症状相比，喘息是最具特异性的症状（成人和儿童分别为78%和89.5%）。总的来说，呼吸道症状对诊断花粉诱发哮喘的阳性预测值较差，但儿童喘息除外，其阳性预测值高达72.7%。咳嗽是成人和儿童花粉诱发哮喘的主要症状。喘息是花粉诱发儿童哮喘的可靠预测因子。在成人中，呼吸道症状对于诊断花粉诱发的哮喘并不足够可靠。
The diagnosis of asthma is made on the basis of variable respiratory symptoms and supported by objective evidence of variable airflow limitation. However, spirometry and bronchoprovocation tests may not be routinely available in resource-scarce settings or in the context of large-scale epidemiological studies. There is a gap in knowledge about the predictive value of respiratory symptoms for the diagnosis of pollen-induced asthma. The aim of this study was to investigate the predictive value of self-reported respiratory symptoms for diagnosing pollen-induced asthma. We recruited 1,161 patients with respiratory symptoms who presented to the respiratory medicine outpatient clinic of two central hospitals in Inner Mongolia during the pollen season of July–September 2015. All patients were interviewed by a respiratory physician and completed a questionnaire survey, lung function tests and skin prick tests for common inhaled allergens. A total of 392 patients (33.8%) were diagnosed with asthma and 292 (25.2%, 160 adults, 132 children) with pollen-induced asthma. Respiratory symptoms of cough, wheezing, dyspnea, chest pain and nocturnal awakenings due to breathlessness were all associated with increased odds of being diagnosed with pollen-induced asthma, with cough being the most common symptom in both adults and children, giving a sensitivity of 90.6% in adults and 88.6% in children. Wheezing was the most specific symptom (78% and 89.5% in adults and children, respectively) compared to other symptoms. Overall, the positive predictive value of respiratory symptoms was poor for diagnosing pollen-induced asthma, with the exception of wheezing in children which had a high positive predictive value of 72.7%. Cough was the predominant symptom in adults and children with pollen-induced asthma. Wheezing was a reliable predictor of pollen-induced asthma in children. In adults, respiratory symptoms were not sufficiently reliable for diagnosing pollen-induced asthma.