文摘

背景:没有协议支气管扩张剂反应应该如何表达。理想情况下,使用的指数应该能够区分哮喘和慢性阻塞性肺疾病和独立的初始残。方法:二百七十四名成年人(年龄在18 - 60岁之间的年)与阻塞性气道疾病门诊病人进行了研究。患者分为综合征组的基础上一个标准化的历史:哮喘(n = 99)、哮喘支气管炎(n = 88)、和慢性阻塞性肺病(n = 51);36个学科不能归因于任何子群。残测定前20分钟后吸入的特布他林1000微克。不同表情的支气管扩张剂反应(δFEV1)比较对他们的依赖初始FEV1和功效分离学科与哮喘和慢性阻塞性肺病。三角洲FEV1被表示为一个百分比的初始FEV1(δFEV1%init)的绝对值(δFEV1[1]),预测的百分比FEV1(δFEV1%pred)的标准化剩余(δSR-FEV1)和百分比最大可能的增加(δFEV1% [pred-init])。结果:δFEV1%init更依赖于初始残比δFEV1 (p = -0.405) [1] (r = -0.145),δFEV1%pred (r = -0.166),和δSR-FEV1 (r = -0.127)。三角洲FEV1% [pred-init]达到无穷当初始FEV1接近预测的水平。 delta FEV1%pred had a higher likelihood ratio (1.71) for separating patients with asthma from those with chronic obstructive lung disease than other expressions of bronchodilator response. Asthmatic patients had larger mean bronchodilator responses than patients in other subgroups; this difference was largest for delta SR-FEV1 (F = 9.19) and delta FEV1%pred (F = 9.03); it was much smaller for delta FEV1%init (F = 5.89). Despite significant differences in mean response, there was a large overlap of individual responses between diagnostic subgroups. The bronchodilator response was continuously and unimodally distributed for all expressions. CONCLUSIONS: delta FEV1%pred appears to be the most useful method of expressing bronchodilator response, both for clinical and for research purposes. Reversibility of airways obstruction in response to a bronchodilator is a continuous variable and not a dichotomous triat. Any cut off level of a "positive" bronchodilator response is therefore arbitrary.