Gupta Prahlad Rai, Mehrotra Ashok Kumar, Khublani Trilok Kumar, Soni Shradha, Feroz Asif
Department of Respiratory Medicine, NIMS Medical College and Hospital, Jaipur, Rajasthan, India.
Lung India. 2015 Jan-Feb;32(1):20-3. doi: 10.4103/0970-2113.148432.
Differentiating asthma from chronic obstructive pulmonary disease (COPD) is difficult. Steroid trial may be of help but has several pitfalls. The present study aims to assess the value of past clinical profile of asthma and its differential diagnosis from COPD in male smokers and thereby to formulate clinical parameters to diagnose bronchial asthma in such patients.
Male smokers who reported at the Respiratory Medicine Department of the National Institute of Medical Sciences (NIMS) Hospital, Jaipur, (India), with shortness of breath (SOB) and showing less than 12% postbronchodilator bronchial reversibility (BR) on spirometry were recruited. These patients were given oral prednisolone 1 mg/kg for two weeks. Post steroid (PS) spirometry was performed to ascertain BR. The past clinical history was recorded and analyzed to determine if it is of any use in differentiating asthma from COPD.
Out of 104 patients, four were lost to follow up, 52 were diagnosed as bronchial asthma, and the remaining 48 as COPD. It was revealed that past history of (H/O) seasonal variation, wheezing, eye allergy, nasal allergy, dust allergy, skin allergy, and family H/O asthma/allergy were positive in 50, 40, 34, 30, 18, 14, and 12 asthma patients as compared to 10, 8, 2, 4, 6, 0, and 0 in 48 COPD patients (P < 0.001). The odds ratio (OR) for diagnosing asthma was highest for the presence of any other two symptoms/variables, besides SOB, in the past (OR = 275, P < 0.0001).
Past clinical history is of immense value in differentiating asthma from COPD in male smokers presenting with SOB and fixed airway obstruction.
区分哮喘与慢性阻塞性肺疾病（COPD）存在困难。类固醇试验可能有所帮助，但存在一些缺陷。本研究旨在评估男性吸烟者哮喘既往临床特征及其与COPD鉴别诊断的价值，从而制定此类患者支气管哮喘的诊断临床参数。
招募了在印度斋浦尔国家医学科学研究所（NIMS）医院呼吸内科就诊、有呼吸急促（SOB）且肺功能测定显示支气管扩张剂后支气管可逆性（BR）小于12%的男性吸烟者。这些患者接受为期两周的口服泼尼松龙1 mg/kg治疗。进行类固醇治疗后（PS）肺功能测定以确定BR。记录并分析既往临床病史，以确定其在区分哮喘与COPD方面是否有用。
104例患者中，4例失访，52例被诊断为支气管哮喘，其余48例为COPD。结果显示，50例、40例、34例、30例、18例、14例和12例哮喘患者有季节性变化、喘息、眼部过敏、鼻部过敏、粉尘过敏、皮肤过敏以及哮喘/过敏家族史等既往病史，而48例COPD患者中分别为10例、8例、2例、4例、6例、0例和0例（P<0.001）。除SOB外，过去存在任何其他两种症状/变量时诊断哮喘的比值比（OR）最高（OR = 275，P<0.0001）。
对于出现SOB和固定性气道阻塞的男性吸烟者，既往临床病史在区分哮喘与COPD方面具有巨大价值。
