Turner-Warwick M, Openshaw P
Cardiothoracic Institute, London, UK.
Postgrad Med J. 1987;63 Suppl 1:79-82.
A detailed questionnaire concerning sputum production was completed by 130 patients with variable airflow limitation fulfilling conventional criteria for asthma. The mean age at onset was 17 years and 75% had positive prick skin tests. One hundred of 130 (79%) reported sputum production; 21% were non secretors. In 68% of those with sputum it was a constant feature from the onset. Increased volumes of sputum was associated with more severe asthma and disability and negative skin tests. An additional component of persisting airflow limitation was found more frequently in the group characterized by no sputum and large volumes. It was less common in those with small sputum volumes. Irrespective of volume, 43% of 130 fulfilled the conventional criteria for MRC chronic bronchitis but 57% of these were non-smokers. We conclude that asthma and chronic bronchitis are not mutually exclusive diagnoses; a history of regular sputum production may lead to the underdiagnosis of asthma and its consequent under-treatment.
130例符合哮喘传统标准的气流受限患者完成了一份关于痰液产生情况的详细问卷。发病时的平均年龄为17岁，75%的患者皮肤点刺试验呈阳性。130例患者中有100例（79%）报告有痰液产生；21%为非分泌型。在有痰液的患者中，68%从发病起就有持续咳痰的症状。痰液量增加与更严重的哮喘、功能障碍及阴性皮肤试验相关。在以无痰和大量痰液为特征的组中，持续性气流受限的额外成分更为常见。在痰液量少的患者中则较少见。无论痰液量多少，130例中有43%符合医学研究委员会（MRC）慢性支气管炎的传统标准，但其中57%为非吸烟者。我们得出结论，哮喘和慢性支气管炎并非相互排斥的诊断；有规律咳痰史可能导致哮喘的漏诊及其后续治疗不足。
