Li J T, O'Connell E J
Division of Allergic Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
Ann Allergy Asthma Immunol. 1996 Jan;76(1):1-13; quiz 13-5. doi: 10.1016/S1081-1206(10)63400-X.
The purpose of this article is to review the medical history and physical examination of the asthmatic patient.
English references identified from relevant articles and book chapters, experts, and MEDLINE search, using "asthma," "physical diagnosis," and "medical history."
Clinical studies of the medical history or physical examination in subjects with respiratory disease were selected for review.
Symptoms such as wheezing, chest tightness and difficulty in taking a deep breath suggest asthma, while symptoms such as gasping, smothering or air hunger suggest alternative diagnoses. Symptoms of asthma correlate poorly with airway obstruction in one-third to one-half of asthmatic patients. Respiratory signs such as wheezing, breath sound intensity, forced expiratory time, accessory muscle use, respiratory rate and pulsus paradoxus correlate roughly with airway obstruction. However, clinicians disagree on the presence or absence of respiratory signs 55% to 89% of the time. Furthermore, physicians correctly predict pulmonary function based on history and physical examination only about half the time, and correctly diagnose asthma based on the clinical examination 63% to 74% of the time.
The medical history and physical examination are moderately effective in diagnosing asthma and estimating its severity. Objective measures of lung function are necessary for the accurate diagnosis of asthma.
本文旨在综述哮喘患者的病史及体格检查情况。
从相关文章、书籍章节、专家以及通过使用“哮喘”“体格诊断”和“病史”进行医学文献数据库检索中获取的英文参考文献。
选取有关呼吸系统疾病患者病史或体格检查的临床研究进行综述。
诸如喘息、胸闷和深呼吸困难等症状提示哮喘，而诸如喘气、窒息感或空气饥饿感等症状提示其他诊断。在三分之一至二分之一的哮喘患者中，哮喘症状与气道阻塞的相关性较差。诸如喘息、呼吸音强度、用力呼气时间、辅助肌使用情况、呼吸频率和奇脉等呼吸体征与气道阻塞大致相关。然而，临床医生在呼吸体征是否存在的判断上，有55%至89%的时间存在分歧。此外，医生仅根据病史和体格检查正确预测肺功能的概率约为一半，而根据临床检查正确诊断哮喘的概率为63%至74%。
病史和体格检查在诊断哮喘及其严重程度评估方面有一定效果。肺功能的客观检测对于准确诊断哮喘是必要的。
