Wright Anne L, Stern Debra A, Kauffmann Francine, Martinez Fernando D
Arizona Respiratory Center, Arizona Health Sciences Center, Tucson, Arizona 85724, USA.
Pediatr Pulmonol. 2006 Apr;41(4):318-25. doi: 10.1002/ppul.20373.
Studies identified gender differences in diagnosed asthma, but the extent to which they can be attributed to differences in symptom experience and frequency rather than factors influencing diagnosis has not been established. We investigated prevalence of, and consultation for, asthma symptoms, as well as diagnosis and treatment in 533 boys and 556 girls enrolled in the Tucson Children's Respiratory Study, a population-based birth-cohort study. Questionnaires regarding respiratory symptoms and diagnoses were obtained at ages 2, 3, 6, 8, 11, 13, 16, and 18 years. Boys were significantly more likely than girls to experience both wheeze and frequent wheeze most years in the first decade of life. However, girls with symptoms were less likely than boys to see a physician (74.1% vs. 83.4%, P < 0.001) and to be labeled as having asthma (43.3% vs. 53.8%, P < 0.009), even after adjusting for symptom frequency. A difference in symptom presentation also appeared to influence diagnosis: nocturnal cough without frequent wheeze was more prevalent among girls, and was associated with reduced diagnosis of asthma. Among subjects who consulted a physician for wheeze, boys were significantly more likely than girls to have taken medication (81.5% vs. 73.5%, P < 0.01). The lag time between age at first wheeze and first use of medication among those consulting a physician for wheeze or asthma was greater for girls, especially among subjects with frequent wheeze (2.8 vs. 1.6 years, P < 0.005). These findings indicate that gender differences in the diagnosis and treatment of asthma cannot be explained completely by differences in symptom prevalence and frequency.
研究发现，在已确诊的哮喘病例中存在性别差异，但这些差异在多大程度上可归因于症状体验和频率的不同，而非影响诊断的因素，目前尚无定论。我们调查了参与图森儿童呼吸研究（一项基于人群的出生队列研究）的533名男孩和556名女孩的哮喘症状患病率、咨询情况以及诊断和治疗情况。在2岁、3岁、6岁、8岁、11岁、13岁、16岁和18岁时收集了有关呼吸道症状和诊断的问卷。在生命的第一个十年中，大多数年份里男孩比女孩更易出现喘息和频繁喘息。然而，有症状的女孩比男孩看医生的可能性更小（74.1%对83.4%，P<0.001），被诊断为哮喘的可能性也更小（43.3%对53.8%，P<0.009），即使在调整症状频率之后也是如此。症状表现的差异似乎也会影响诊断：无频繁喘息的夜间咳嗽在女孩中更为普遍，且与哮喘诊断率降低有关。在因喘息而咨询医生的受试者中，男孩比女孩服用药物的可能性显著更高（81.5%对73.5%，P<0.01）。因喘息或哮喘而咨询医生的人群中，女孩从首次喘息到首次用药的间隔时间更长，尤其是在频繁喘息的受试者中（2.8年对1.6年，P<0.005）。这些发现表明，哮喘诊断和治疗中的性别差异不能完全用症状患病率和频率的差异来解释。
