Kolnaar B, Beissel E, van den Bosch W J, Folgering H, van den Hoogen H J, van Weel C
Department of General Practice and Social Medicine, Faculty of Medical Sciences, Katholieke Universiteit, Nijmegen, The Netherlands.
Fam Pract. 1994 Jun;11(2):133-40. doi: 10.1093/fampra/11.2.133.
The objectives of this study were to investigate underdiagnosis of asthma in adolescents and young adults in general practice and to examine the influence of patient characteristics. The results of screening on asthma (questionnaire, spirometry) were compared with the diagnosis made in general practice. Screening results served as the reference standard. Four general practices forming the Continuous Morbidity Registration, Nijmegen were used. Five-hundred and fifty-one subjects aged 10-23, registered since their birth till the year of the study (1989) on the practice lists of these practices were involved in the study. The data collected included: (i) all episodes of respiratory morbidity in their life presented in general practice; (ii) socioeconomic level and family history of asthma; and (iii) current respiratory status, allergy to inhalant allergens and smoking behaviour (questionnaire, spirometry, histamine-challenge test and Phadiatop-test). The screening identified asthma in 19% of the study subjects, of whom 56% not had been recognized in general practice. Of the asthmatics recognized in general practice, significantly more were boys, had presented acute bronchitis in the last 5 years preceding this study and had a family history of asthma than those not recognized. Of the latter, 30% had not presented any respiratory disease in the last 5 years to their general practitioner (GP). This study suggests underdiagnosis of asthma in adolescents and young adults. Asthmatics are more likely to be recognized by their GPs in case of male sex, previous diagnosis of acute bronchitis and a family history of asthma. Reluctance of some patients to consult their doctor and low perception of symptoms may play a role in underdiagnosis.
本研究的目的是调查全科医疗中青少年和青年成人哮喘的漏诊情况，并考察患者特征的影响。将哮喘筛查结果（问卷、肺功能测定）与全科医疗中的诊断结果进行比较。筛查结果作为参考标准。研究采用了奈梅亨市连续发病登记处的四家全科诊所。551名年龄在10 - 23岁之间、自出生起至研究年份（1989年）在这些诊所的诊疗名单上登记的受试者参与了研究。收集的数据包括：（i）他们一生中在全科医疗中出现的所有呼吸道发病情况；（ii）社会经济水平和哮喘家族史；以及（iii）当前的呼吸状况、对吸入性过敏原的过敏情况和吸烟行为（问卷、肺功能测定、组胺激发试验和Phadiatop试验）。筛查在19%的研究受试者中发现了哮喘，其中56%在全科医疗中未被识别。在全科医疗中被识别出的哮喘患者中，与未被识别出的患者相比，男孩明显更多，在本研究前的最近5年中曾患急性支气管炎，且有哮喘家族史。在后者中，30%在过去5年中未向其全科医生（GP）报告过任何呼吸道疾病。本研究提示青少年和青年成人哮喘存在漏诊情况。哮喘患者如果是男性、既往有急性支气管炎诊断和哮喘家族史，则更有可能被其全科医生识别。一些患者不愿就医以及对症状的低认知可能在漏诊中起作用。
