Torén K, Brisman J, Järvholm B
Department of Occupational Medicine, Sahlgrenska Hospital, University of Göteborg, Sweden.
Chest. 1993 Aug;104(2):600-8. doi: 10.1378/chest.104.2.600.
The first widely used questionnaire in respiratory epidemiology was the questionnaire from the Medical Research Council (MRC) of Great Britain. In the first version, from 1960, there were only a few questions about wheezing, but in later editions, more questions about asthma and asthma-like symptoms were added. The MRC questionnaire initiated the development of other questionnaires such as the European Community for Coal and Steel (ECSC) questionnaire of respiratory symptoms and the questionnaire from the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78). In Tucson, Ariz, a questionnaire was developed in the 1970s that was focused on the subject's own report of asthma. In Great Britain, a questionnaire was developed in the 1980s with the intention of finding the most valid symptom-based items for identifying asthma, "the IUATLD (1984) questionnaire." When judging the validity of a questionnaire, it is essential to understand sensitivity and specificity. Sensitivity is the fraction of the truly diseased subjects found to be diseased using the questionnaire. Specificity is the fraction of the truly healthy subjects found to be healthy using the questionnaire. Regarding questionnaires dealing with asthma, the situation is confusing because of the absence of any gold standard for asthma. The most usual mode of validation has been to test the questionnaire against the results of a clinical physiologic investigation, often a nonspecific bronchial challenge test. Another approach has been to compare the answers from the questionnaire with the clinical diagnoses of asthma. When validated in relation to bronchial challenge tests, the questions about self-reported asthma have a mean sensitivity of 36 percent (range, 7 to 80 percent) and a mean specificity of 94 percent (range, 74 to 100 percent). The questions about "physician-diagnosed asthma" have even higher specificity, 99 percent. When validated in relation to a clinical diagnosis of asthma, the mean sensitivity for the question about self-reported asthma was 68 percent in the reviewed studies (range, 48 to 100 percent). The specificity was 94 percent (range, 78 to 100 percent). One problem in using the presence of bronchial hyperreactivity (BHR) as a gold standard for asthma is that many people with BHR report no respiratory complaints. In other words, the presence of BHR is a measure with high sensitivity but low specificity for asthma. The effect of using a methacholine challenge test as a standard for the disease will thus be an underestimation of the sensitivity of the questionnaire.(ABSTRACT TRUNCATED AT 400 WORDS)
呼吸流行病学中首个被广泛使用的问卷是英国医学研究委员会（MRC）的问卷。1960年的第一版中，关于喘息的问题只有寥寥几个，但在后续版本中，增加了更多关于哮喘及类似哮喘症状的问题。MRC问卷推动了其他问卷的发展，比如欧洲煤钢共同体（ECSC）的呼吸道症状问卷以及美国胸科学会和肺病科（ATS-DLD-78）的问卷。在亚利桑那州图森市，20世纪70年代开发了一份聚焦于受试者自身哮喘报告的问卷。在英国，20世纪80年代开发了一份问卷，旨在找出用于识别哮喘的基于症状的最有效条目，即“国际抗痨和肺部疾病联盟（1984）问卷”。在判断一份问卷的有效性时，理解敏感性和特异性至关重要。敏感性是指使用该问卷发现的真正患病受试者的比例。特异性是指使用该问卷发现的真正健康受试者的比例。对于涉及哮喘的问卷而言，由于缺乏哮喘的金标准，情况较为复杂。最常见的验证方式是将问卷与临床生理检查结果进行对比，通常是进行非特异性支气管激发试验。另一种方法是将问卷答案与哮喘的临床诊断结果进行比较。在与支气管激发试验相关的验证中，关于自我报告哮喘的问题平均敏感性为36%（范围为7%至80%），平均特异性为94%（范围为74%至100%）。关于“医生诊断的哮喘”的问题特异性甚至更高，为99%。在与哮喘临床诊断相关的验证中，在综述研究中，关于自我报告哮喘问题的平均敏感性为68%（范围为48%至100%）。特异性为94%（范围为78%至100%）。将支气管高反应性（BHR）的存在用作哮喘金标准存在的一个问题是，许多有BHR的人并无呼吸道症状主诉。换句话说，BHR的存在对哮喘而言是一项敏感性高但特异性低的指标。因此，将乙酰甲胆碱激发试验用作该疾病的标准会低估问卷的敏感性。（摘要截选至400词）
