英国基层医疗中气道阻塞的诊断：1997 - 2001年CADRE（慢性阻塞性肺疾病和哮喘诊断/管理再评估）项目
Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001.
作者信息
Pearson Mike, Ayres Jon G, Sarno Maria, Massey Dan, Price David
机构信息
Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.
出版信息
Int J Chron Obstruct Pulmon Dis. 2006;1(4):435-43. doi: 10.2147/copd.2006.1.4.435.
OBJECTIVE
Asthma and COPD require different management strategies, but differentiation in primary care is difficult. This primary care support initiative observed the impact of spirometry and clinical assessment on the diagnosis of airway disease.
MATERIALS AND METHODS
Of 61,191 patients aged > or =40 years being treated for respiratory conditions within 1003 UK primary care practices, 43,203 underwent a diagnostic review including standardized spirometric assessment. The proportion of patients in whom the diagnosis was changed by the additional information was determined. The relationship of various patient characteristics was compared with the baseline and review diagnoses and with any change in diagnosis.
RESULTS
Asthma was initially diagnosed in 43% of patients, COPD in 35%, mixed disease in 9%, and other respiratory condition in 13%. Patients initially diagnosed with asthma, mixed disease, or another condition were more likely to have their diagnosis changed at review (54%, 46%, and 63%, respectively) than those initially diagnosed with COPD (14%). A change from asthma to COPD was associated with male gender, smoking, older age, and reduced lung function, the opposite being associated with a change from COPD to asthma.
CONCLUSION
In this study, a clinical review supplemented by additional information including spirometry highlights apparent mislabeling of significant numbers of patients with chronic obstructive disease in general practice with significant implications for individual treatment and healthcare provision. This study shows that the addition of more clinical information can have a major effect on diagnostic tendency in patients with airway disease. An initial diagnosis of COPD seems less likely to change following review than an asthma diagnosis. While it is likely that greater information leads to a more accurate diagnosis, the differential effect of new information on diagnostic labeling highlights the insecurity of the diagnostic process in primary care in the UK.
目的
哮喘和慢性阻塞性肺疾病（COPD）需要不同的管理策略，但在初级保健中进行区分却很困难。这项初级保健支持倡议观察了肺功能测定和临床评估对气道疾病诊断的影响。
材料与方法
在英国1003家初级保健机构中，对61191名年龄≥40岁且正在接受呼吸道疾病治疗的患者进行研究，其中43203名患者接受了包括标准化肺功能评估在内的诊断性复查。确定因额外信息而改变诊断的患者比例。将各种患者特征与基线诊断、复查诊断以及诊断变化进行比较。
结果
最初诊断为哮喘的患者占43%，COPD占35%，混合性疾病占9%，其他呼吸道疾病占13%。最初诊断为哮喘、混合性疾病或其他疾病的患者在复查时诊断更有可能改变（分别为54%、46%和63%），而最初诊断为COPD的患者诊断改变的可能性为14%。从哮喘转变为COPD与男性、吸烟、年龄较大和肺功能下降有关，而从COPD转变为哮喘则与上述因素相反。
结论
在本研究中，通过包括肺功能测定在内的额外信息进行的临床复查凸显了在全科医疗中大量慢性阻塞性疾病患者存在明显的误诊情况，这对个体治疗和医疗服务提供具有重大影响。这项研究表明，增加更多临床信息可对气道疾病患者的诊断倾向产生重大影响。与哮喘诊断相比，最初诊断为COPD在复查后似乎不太可能改变。虽然更多信息可能会带来更准确的诊断，但新信息对诊断标签的不同影响凸显了英国初级保健中诊断过程的不稳定性。
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