Sint Franciscus Gasthuis, Department of Pulmonology, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
Respir Med. 2013 Sep;107(9):1356-64. doi: 10.1016/j.rmed.2013.05.007. Epub 2013 Jun 10.
The prevalence of obesity and asthma has increased concurrently over the last decades, suggesting a link between obesity and asthma. However, asthma might not be adequately diagnosed in this population.
To investigate whether not only overdiagnosis but also underdiagnosis of asthma is present in an obese population.
Morbidly obese subjects with or without physician-diagnosed asthma were recruited from a pre-operative screening programme for bariatric surgery, and were characterized using an extensive diagnostic algorithm.
473 subjects were screened; 220 met inclusion criteria, and 86 agreed to participate. Among the 32 participating subjects who had a physician diagnosis of asthma, reversible airway obstruction and/or bronchial hyperresponsiveness could only be detected in 19 patients (59%, 95% CI [0.41-0.76]), whereas in 13 patients (41%, 95% CI [0.24-0.50]) the diagnosis of asthma could not be confirmed (overdiagnosis). In contrast, in the remaining 54 patients, 17 (31%, 95% CI [0.20-0.46]) were newly diagnosed with asthma (underdiagnosis).
Besides overdiagnosis, there is also substantial underdiagnosis of asthma in the morbidly obese. Symptoms could be incorrectly ascribed to either obesity or asthma, and therefore also in the morbidly obese the diagnosis of asthma should also be based on pulmonary function testing.
肥胖症和哮喘的患病率在过去几十年中同时增加，这表明肥胖症和哮喘之间存在关联。然而，在肥胖人群中，哮喘可能没有得到充分诊断。
研究肥胖人群中是否不仅存在哮喘的过度诊断，还存在哮喘的漏诊。
从减肥手术的术前筛查计划中招募了患有或未被医生诊断为哮喘的病态肥胖患者，并使用广泛的诊断算法对其进行了特征描述。
对 473 名患者进行了筛查；220 名符合纳入标准，86 名同意参与。在 32 名被医生诊断为哮喘的参与研究的患者中，只有 19 名患者（59%，95%CI[0.41-0.76]）可检测到气道可逆性阻塞和/或支气管高反应性，而在 13 名患者（41%，95%CI[0.24-0.50]）中无法确认哮喘的诊断（过度诊断）。相比之下，在其余 54 名患者中，17 名（31%，95%CI[0.20-0.46]）被新诊断为哮喘（漏诊）。
除了过度诊断，肥胖症患者中还存在大量哮喘的漏诊。症状可能被错误地归因于肥胖症或哮喘，因此，在肥胖症患者中，哮喘的诊断也应基于肺功能测试。
