Randolph C, Fraser B, Matasavage C
St. Mary's Hospital, Division of Yale Regional Pediatric Program, Connecticut, USA.
Allergy Asthma Proc. 1997 Mar-Apr;18(2):93-8. doi: 10.2500/108854197778605527.
As part of a multicenter study envisioned by the American College of Allergy Sports Committee to screen for exercise-induced asthma, 303 high school students, freshman and sophomore gym classes, completed a questionnaire concerning exercise-related asthma, chronic asthma, and atopy. The study group included 124 females (41%) and 179 males (59%) with an average and median age of 15 years and a range of 13-17 years, and included 99% Caucasian and 1% nonCaucasian students, all attending the same parochial high school. After obtaining informed consent, 112 (37%) agreed to a free running test with initial challenge on an outdoor cinder track during April-June 1995. All challenges were conducted between 8:00 A.M. and noon with relative-humidity 59% and average temperature 15 degrees C. The challenge consisted of 7 minutes of continuous running on the cinder track with a doubling of pulse rate to 160/min during the run. Peak expiratory flows were taken at baseline, 0, 5, and 10 minutes postexercise. Twenty nine of 112 (26%) of the students were initially assessed as positive challenges, defined as a 15% decline in peak flow following exercise on the first challenge. However, four students self-recovered; thus 25 of 112 (22%) were qualified as true positives. Of these 25, 20 (80%) agreed to be reexercised. Fourteen of 20 (70%) were positive, yielding a prevalence rate of 14/112 (12.5%). Sixteen of these 20 (80%) were then exercised a third time using spirometry pre- and postexercise. Eight were positive, yielding a prevalence rate of 8/112 (7%). The questionnaire correlated significantly with the challenge, particularly when read by section (p = 0.000001) rather than globally positive or negative (p = 0.00008), with a specificity of 64%, sensitivity of 94%, positive predictive value of 44%, and negative predictive value of 97%. In summary, inexpensive and familiar free-running tests can be a useful screening test to confirm the questionnaire which is sensitive (94%) in ruling in, but has low specificity (64%) in ruling out, exercise-induced asthma.
作为美国过敏症运动委员会设想的一项多中心研究的一部分，该研究旨在筛查运动诱发的哮喘，303名高中生，即新生和二年级的体育课学生，完成了一份关于运动相关哮喘、慢性哮喘和特应性的问卷。研究组包括124名女性（41%）和179名男性（59%），平均年龄和中位数年龄均为15岁，年龄范围在13 - 17岁之间，且99%为白人学生，1%为非白人学生，他们都就读于同一所教会高中。在获得知情同意后，112名学生（37%）同意在1995年4月至6月期间在户外煤渣跑道上进行一次初始激发的自由跑步测试。所有激发测试均在上午8点至中午之间进行，相对湿度为59%，平均温度为15摄氏度。激发测试包括在煤渣跑道上持续跑步7分钟，跑步过程中脉搏率加倍至160次/分钟。在基线、运动后0、5和10分钟测量呼气峰值流量。112名学生中有29名（26%）在首次激发测试中最初被评估为激发试验阳性，定义为运动后峰值流量下降15%。然而，有4名学生自行恢复；因此，112名学生中有25名（22%）被判定为真正的阳性。在这25名学生中，20名（80%）同意再次进行测试。20名学生中有14名（70%）为阳性，患病率为14/112（12.5%）。然后，这20名学生中有16名（80%）第三次进行测试，运动前后使用肺活量测定法。其中8名学生为阳性，患病率为8/112（7%）。问卷与激发测试显著相关，特别是按部分阅读时（p = 0.000001），而不是整体判断为阳性或阴性时（p = 0.00008），其特异性为64%，敏感性为94%，阳性预测值为44%，阴性预测值为97%。总之，廉价且常见的自由跑步测试可以作为一种有用的筛查测试，用于确认问卷结果，该问卷在诊断运动诱发哮喘方面敏感性较高（94%），但在排除方面特异性较低（64%）。
