Defining asthma in epidemiological studies

被引:212
作者
Pekkanen, J
Pearce, N
机构
[1] Natl Publ Hlth Inst, Unit Environm Epidemiol, Kuopio 70701, Finland
[2] Wellington Sch Med, Wellington Asthma Res Grp, Wellington, New Zealand
关键词
asthma; bronchial hyperreactivity; questionnaires; sensitivity and specificity; validity;
D O I
10.1034/j.1399-3003.1999.14d37.x
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
It has been suggested that, in epidemiological studies, asthma should be defined as symptomatic bronchial hyperresponsiveness (BHR). This paper critically examines the validity of this and alternative methods of defining asthma by reviewing population-based studies validating BHR and symptom questionnaires against asthma defined on the basis of a clinical assessment. It is emphasized that a single definition of asthma sill not be applicable to all studies. When the aim of a study is to compare differences in prevalence of asthma between populations, Youden's Index (sensitivity + specificity - 1) is the best single measure of validity. BHR has similar or better specificity, but much worse sensitivity, and therefore a worse Youden's Index, than symptom questionnaires. When the aim is to estimate relative risks, the validity of the definition of asthma depends more on its positive predictive value. Therefore, more specific methods of detecting asthmatics, such as severe symptoms, diagnoses of asthma, or symptomatic BHR may be most useful in cohort and case-control studies. In contrast, conversely, the method of choice for the first phase of prevalence comparisons is standardized written or video symptom questionnaires. In order to explore reasons for the differences in asthma prevalence, and to estimate possible differential symptom reporting, questionnaires can be supplemented with bronchial hyperresponsiveness and other testing in subsamples of the symptomatic and nonsymptomatic subjects. However, symptoms and bronchial hyperresponsiveness should usually be analysed separately rather than combined due to the poor agreement between bronchial hyperresponsiveness and clinical asthma.
引用
收藏
页码:951 / 957
页数:7
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