Lukrafka Janice L, Fuchs Sandra C, Moreira Leila B, Picon Rafael V, Fischer Gilberto B, Fuchs Flavio D
School of Physiotherapy, Rede Metodista de Educação do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
J Asthma. 2010 Mar;47(2):166-9. doi: 10.3109/02770900903483766.
The epidemiology of asthma has been investigated with questionnaires, such as the International Study of Asthma and Allergies in Childhood protocol.
To investigate the performance of the questions of the International Study of Asthma and Allergies in Childhood questionnaire to diagnose asthma in adolescents.
This is a population-based cross-sectional study of adolescents in the Syndrome of Obesity and Risk Factors for Cardiovascular Disease study. The validity of the asthma symptoms of the International Study of Asthma and Allergies in Childhood protocol was assessed by calculating sensitivity, specificity, positive and negative posttest probabilities, and Youden's Index, taking as a gold standard the history of a medical diagnosis of asthma. Risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for sex and age, were calculated using Cox regression model.
In total, 575 adolescents were investigated. Overall, 28.7% reported a lifetime medical diagnosis of asthma, and 40.0% reported at least one episode of wheezing. Ever wheezing had the highest sensitivity (80.6%) for the diagnosis of asthma, compared with the other ISAAC questions. Adolescents who reported ever wheezing were about 8 times more likely (adjusted RR: 8.3; 95% CI: 4.9-14.2) to have ever had asthma, independent of age and sex. Symptoms within the last 12 months (wheezing, cough without cold or respiratory infection, sleep disturbed due to wheezing, wheezing due to exercise, speech limited due to wheezing) had specificity of 92.0% or higher. Dry cough at night without cold or respiratory infection was the strongest independent predictor of asthma (adjusted RR: 8.8; 95% CI: 6.1-12.7).
Ever wheezing is the most sensitive indicator of the diagnosis of asthma but falsely identifies a portion of adolescents as asthmatic. Symptoms of asthma in the last 12 months, such as cough without cold or respiratory infection, are rarely positive in the absence of a lifetime asthma diagnosis. The combination of ever wheezing for screening and the presence of other symptoms within the past 12 months to confirm the diagnosis could be an effective strategy to identify the prevalence of asthma in communities.
哮喘的流行病学已通过问卷调查进行研究，例如儿童哮喘和过敏国际研究方案。
调查儿童哮喘和过敏国际研究问卷中的问题在诊断青少年哮喘方面的表现。
这是一项基于人群的肥胖与心血管疾病危险因素综合征研究中的青少年横断面研究。以哮喘的医学诊断史作为金标准，通过计算敏感性、特异性、阳性和阴性验后概率以及约登指数，评估儿童哮喘和过敏国际研究方案中哮喘症状的有效性。使用Cox回归模型计算调整性别和年龄后的风险比（RRs）和95%置信区间（CIs）。
总共调查了575名青少年。总体而言，28.7%的人报告有哮喘的终生医学诊断，40.0%的人报告至少有一次喘息发作。与其他儿童哮喘和过敏国际研究（ISAAC）问题相比，曾经喘息对哮喘诊断的敏感性最高（80.6%）。报告曾经喘息的青少年患过哮喘的可能性约为8倍（调整后的RR：8.3；95%CI：4.9 - 14.2），与年龄和性别无关。过去12个月内的症状（喘息、无感冒或呼吸道感染的咳嗽、因喘息导致睡眠障碍、运动性喘息、因喘息导致说话受限）特异性为92.0%或更高。无感冒或呼吸道感染的夜间干咳是哮喘最强的独立预测因素（调整后的RR：8.8；95%CI：6.1 - 12.7）。
曾经喘息是哮喘诊断最敏感的指标，但会错误地将一部分青少年认定为哮喘患者。过去12个月内的哮喘症状，如无感冒或呼吸道感染的咳嗽，在没有哮喘终生诊断的情况下很少呈阳性。将曾经喘息用于筛查以及过去12个月内存在其他症状以确诊的联合方法，可能是确定社区哮喘患病率的有效策略。
