Barbee R A
Division of Respiratory Sciences, University of Arizona, Tucson.
Monogr Allergy. 1987;21:21-41.
As noted earlier, the clinician and the epidemiologist are in many respects in similar positions in terms of our current understanding of asthma. Through the efforts of the pharmaceutical industry the practitioner has a much wider range of therapeutic tools available to manage reversible airways disease. B-agonists are more specific, have a longer duration of action, minimizing the potential for abuse and coincident toxicity. Theophylline preparations are long-acting and therapeutic drug levels can be accurately assessed. Inhaled corticosteroids provide the opportunity to reduce the negative side aspects of hormonal therapy. Unfortunately, with all these tools, the morbidity and mortality of asthma have not been decreased. In fact, it may be that the disease is a greater worldwide health problem than it was a generation ago. Similarly, epidemiologic research has provided us with increasingly meaningful information, not only of the prevalence of the disease, but with recent longitudinal studies, the factors which impact upon disease remission and relapse. Whether we separate the wheezing syndromes into separate categories of wheezy bronchitis, asthmatic bronchitis, and asthma is probably less important than our understanding of a disease entity which is characterized by bronchial hyper-reactivity in response to a variety of stimuli. The most encouraging aspects of recent epidemiologic research have been the selection of representative populations, using standardized methods, from which significant conclusions can be drawn. At the least, these studies have confirmed and extended our knowledge of a disease that we still do not fully understand. Woolcock et al.[56], and others, have included inhalation challenge testing into their epidemiologic protocols in an attempt to add physiologic assessments to the more traditional symptom complexes. Unfortunately, even this addition has not solved the problem of an asthma diagnosis in the older adult population whose irreversible airways obstructive disease is a confounding variable. Even in younger subjects, as reported by Townley et al.[14], a gradation of responses to methacholine inhalation in atopic subjects, may make the identification of asthmatics more difficult than initially thought. The fact that ex-asthmatics appear to retain their hyper-responsiveness, however, could make inhalation challenge a valuable tool in longitudinal epidemiologic research. What can epidemiologic studies contribute in the future?.(ABSTRACT TRUNCATED AT 400 WORDS)
如前所述，就我们目前对哮喘的认识而言，临床医生和流行病学家在很多方面处境相似。通过制药行业的努力，从业者有了更多种类的治疗手段来管理可逆性气道疾病。β受体激动剂更具特异性，作用时间更长，将滥用可能性及相关毒性降至最低。茶碱制剂作用持久，且能准确评估治疗药物水平。吸入性糖皮质激素提供了减少激素治疗负面作用的机会。不幸的是，尽管有了所有这些手段，哮喘的发病率和死亡率并未降低。事实上，这种疾病在全球范围内可能比一代人以前更是一个严重的健康问题。同样，流行病学研究不仅为我们提供了关于该疾病患病率的越来越有意义的信息，而且通过最近的纵向研究，还提供了影响疾病缓解和复发的因素。我们是否将喘息综合征分为喘息性支气管炎、哮喘性支气管炎和哮喘等不同类别，可能不如我们对一种以对多种刺激产生支气管高反应性为特征的疾病实体的理解重要。近期流行病学研究最令人鼓舞的方面是采用标准化方法选择代表性人群，从中得出重要结论。至少，这些研究证实并扩展了我们对一种我们仍未完全理解的疾病的认识。伍尔科克等人[56]以及其他一些人，已将吸入激发试验纳入其流行病学方案，试图在更传统的症状复合体基础上增加生理评估。不幸的是，即便如此，这一补充仍未解决老年人群中哮喘诊断的问题，因为其不可逆性气道阻塞性疾病是一个混杂变量。正如汤利等人[14]所报告的，即使在年轻受试者中，特应性受试者对乙酰甲胆碱吸入的反应分级，也可能使哮喘患者的识别比最初认为的更加困难。然而，既往哮喘患者似乎仍保持其高反应性这一事实，可能使吸入激发试验成为纵向流行病学研究中的一个有价值的工具。未来流行病学研究能做出哪些贡献呢？（摘要截选至400词）
