Nawaz Safia F, Ravindran Mayuran, Kuruvilla Merin E
Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis, and Sleep, Department of Pediatrics.
Department of Internal Medicine.
Curr Opin Pulm Med. 2022 May 1;28(3):251-257. doi: 10.1097/MCP.0000000000000871. Epub 2022 Mar 7.
The global prevalence of asthma continues to increase; however, asthma remains under-diagnosed and under-treated. This results in a significant burden on the healthcare system and preventable patient morbidity and mortality. Over-diagnosis of asthma based on clinical history alone also complicates patient management. This heightens the importance of a prompt and accurate asthma diagnosis. Therefore, a review of the literature was performed regarding both objective diagnostic testing for asthma and using patient-reported outcome measures.
The cornerstone of asthma diagnosis remains spirometry with testing for bronchodilator reversibility testing for pediatric and adult populations. This test may need to be repeated at multiple time points due to its low sensitivity. Peak flow measurement, fractional exhaled nitric oxide testing, and allergy testing are useful adjuncts to the diagnosis and phenotyping of asthma. Bronchoprovocation testing is reserved for people with high clinical suspicion for asthma, but negative spirometry. Novel noninvasive testing modalities may play a diagnostic role in the future. The advent of remote digital health monitoring technology has resulted in revisiting patient-reported outcome measures for the diagnosis and monitoring of asthma.
Overall, improved diagnostic tools for asthma are crucial for earlier recognition and treatment of the disease and improved patient care outcomes worldwide.
全球哮喘患病率持续上升；然而，哮喘仍存在诊断不足和治疗不足的情况。这给医疗系统带来了沉重负担，并导致可预防患者发病和死亡。仅基于临床病史对哮喘进行过度诊断也会使患者管理复杂化。这凸显了及时、准确诊断哮喘的重要性。因此，我们对有关哮喘客观诊断测试和使用患者报告结局指标的文献进行了综述。
哮喘诊断的基石仍然是肺功能测定，对儿童和成人进行支气管扩张剂可逆性测试。由于其敏感性较低，该测试可能需要在多个时间点重复进行。峰值流量测量、呼出一氧化氮分数测试和过敏测试是哮喘诊断和表型分析的有用辅助手段。支气管激发试验适用于临床高度怀疑哮喘但肺功能测定结果为阴性的患者。新型非侵入性测试方法可能在未来发挥诊断作用。远程数字健康监测技术的出现促使人们重新审视用于哮喘诊断和监测的患者报告结局指标。
总体而言，改进哮喘诊断工具对于在全球范围内更早地识别和治疗该疾病以及改善患者护理结局至关重要。
