在向全科医生就诊的持续性咳嗽患者中识别哮喘和慢性阻塞性肺疾病：描述性研究。
Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study.
作者信息
Thiadens H A, de Bock G H, Dekker F W, Huysman J A, van Houwelingen J C, Springer M P, Postma D S
机构信息
Department of General Practice, Leiden University Medical Centre, PO Box 2088, 2301 CB Leiden, Netherlands.
出版信息
BMJ. 1998 Apr 25;316(7140):1286-90. doi: 10.1136/bmj.316.7140.1286.
OBJECTIVE
To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis.
DESIGN
Descriptive study.
SETTING
Primary healthcare centre in the Netherlands.
SUBJECTS
192 patients aged 18-75 years, not known to have asthma or chronic obstructive pulmonary disease, attending their general practitioner with cough persisting for at least 2 weeks. : A diagnosis of asthma or chronic obstructive pulmonary disease was based on the recurrence of airway symptoms in the past year accompanied by spirometric measurements (including bronchodilator testing) and methacholine provocation tests. A scoring formula to estimate the probability of asthma or chronic obstructive pulmonary disease, based on history and physical examination, was generated by means of logistic regression.
RESULTS
74 patients (39%) were classified as having asthma, 14 (7%) as having chronic obstructive pulmonary disease. The best formula for predicting asthma or chronic obstructive pulmonary disease used scores for three symptoms: (reported) wheeze, (reported) dyspnoea, and allergen induced symptoms, together with prolonged expiration, pack years of smoking, and female sex. Variables were scored 1 when present and 0 when absent, except for allergen induced symptoms (1.5) and number of pack years of smoking (n/25). With a cut off value of 3 on the scoring formula, 76% of the patients could be classified correctly.
CONCLUSIONS
About half of patients with persistent cough who present to a general practitioner have asthma or chronic obstructive pulmonary disease. With a simple formula based on three symptoms and prolonged expiration, pack years of smoking, and female sex, most patients may be identified correctly in general practice.
目的
确定在普通诊所就诊、持续咳嗽但此前未被诊断患有哮喘和慢性阻塞性肺疾病的患者中，这两种疾病的患病率，并确定有助于全科医生进行诊断的标准。
设计
描述性研究。
地点
荷兰的一家初级医疗保健中心。
研究对象
192名年龄在18至75岁之间、此前未被诊断患有哮喘或慢性阻塞性肺疾病、因咳嗽持续至少2周而就诊于全科医生的患者。哮喘或慢性阻塞性肺疾病的诊断基于过去一年中气道症状的复发情况，并伴有肺功能测量（包括支气管扩张试验）和乙酰甲胆碱激发试验。通过逻辑回归得出一个基于病史和体格检查来估计哮喘或慢性阻塞性肺疾病患病概率的评分公式。
结果
74名患者（39%）被归类为患有哮喘，14名患者（7%）被归类为患有慢性阻塞性肺疾病。预测哮喘或慢性阻塞性肺疾病的最佳公式使用了三种症状的评分：（自述）喘息、（自述）呼吸困难和变应原诱发症状，以及呼气延长、吸烟包年数和女性性别。除变应原诱发症状（1.5分）和吸烟包年数（n/25）外，各变量存在时评分为1分，不存在时评分为0分。评分公式的截断值为3时，76%的患者能够被正确分类。
结论
在全科医生处就诊的持续咳嗽患者中，约一半患有哮喘或慢性阻塞性肺疾病。通过一个基于三种症状、呼气延长、吸烟包年数和女性性别的简单公式，大多数患者在普通诊所中可能会被正确识别。
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