成人哮喘或慢性阻塞性肺疾病加重住院患者的确认性肺量测定。
Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation.
机构信息
University of Illinios at Chicago, Chicago, IL, USA.
出版信息
BMC Pulm Med. 2012 Dec 7;12:73. doi: 10.1186/1471-2466-12-73.
BACKGROUND
Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation.
METHODS
Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.
RESULTS
There was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007).
CONCLUSIONS
Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.
背景
通过肺活量测定法对气流阻塞进行客观测量是诊断哮喘或 COPD 的重要部分。在加重期，肺活量测定法对确认哮喘或慢性阻塞性肺疾病（COPD）的诊断的可行性和实用性尚不清楚。解决这些知识空白可能有助于确定在临床护理和质量改进工作中进行确认性测试的必要性。本研究旨在确定在因哮喘或 COPD 加重而住院的患者中进行肺活量测定法的可行性，并确定其用于确认诊断的实用性。
方法
在四家学术医疗机构进行的多中心研究。对因哮喘或 COPD 加重而住院的 113 名成年患者进行了肺活量测定法检查。两名经过董事会认证的肺病专家评估了肺活量测定法记录，以确定能够产生足够质量的肺活量测定法数据的患者比例。根据 2005 年欧洲呼吸学会/美国胸科学会的建议，通过评估肺活量测定法记录来判断是否存在阻塞性肺病，从而确定了对确认阻塞性肺病存在的实用性。
结果
接受性（κ=0.92）和可重复性（κ=0.93）的肺活量测定法记录几乎完全一致。75%的检查结果均被两名肺病专家认为具有足够的质量。在这些具有足够质量的测试中，有 22%的测试没有客观证据表明存在阻塞性肺病。与非肥胖患者（33%）相比，肥胖患者（BMI≥30kg/m2）更有可能产生没有阻塞性肺病证据的肺活量测定法记录（33%与 8%，p=0.007）。
结论
在大多数因哮喘或 COPD 加重而住院的成年患者中，都可以获得足够质量的肺活量测定法。确认性肺活量测定法可能是一种有用的工具，可以帮助减少阻塞性肺病的过度诊断，尤其是在肥胖患者中。
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