基于标准问卷的支气管哮喘流行病学

Epidemiology of asthma based on the standard questionnaire

支气管哮喘(简称哮喘)是全球常见的慢性气道疾病。虽然指南推荐了哮喘诊断标准并已经广泛应用于临床实践,但在人群的大型流行病学调查中,常推荐采用标准化的哮喘问卷进行患病率调查,因为标准化的哮喘问卷具有效益高、成本低、应答率高的特点,所得结果也便于在不同人群或地区之间进行比较。目前全球范围内已开展的4项具有较大影响的哮喘流行病学调查,包括欧盟呼吸健康调查(European Community Respiratory Health Survey,ECRHS)、国际儿童哮喘和过敏研究(International Study of Asthma and Allergies in Childhood,ISAAC)、国际婴儿喘息研究(International Study of Wheezing in Infants,EISL)和世界健康调查(World Health Survey,WHS),上述研究结果也是全球疾病负担研究(Global Burden of Disease Study,GBD)估算全球哮喘患病率的重要数据来源。在中国,曾进行过多次儿童、成人哮喘患病率的调查,但是既往调查多采用临床诊断标准定义人群中的哮喘者,因此,所得结果与国际上采用标准问卷所得哮喘患病率无法比较。在中国20岁以上代表性人群中进行的中国肺部健康研究(China Pulmonary Health Study,CPH),采用了与ECRHS一致的哮喘问卷,结果显示,中国成人中表现有喘息症状的哮喘患病率达4.2%,有近4570万成人哮喘患者,但该数据并不包括20岁以下哮喘患者以及不典型哮喘患者。此外,CPH研究还显示,中国成人哮喘的漏诊率高,规范化治疗率低,亟待社会采取措施提高哮喘的诊治与管理水平。

Asthma is a common chronic airway disease in the world.Although the guidelines recommend the diagnostic criteria for asthma,which have been widely used in clinical practice,the standardized asthma questionnaire is often recommended for prevalence surveys in large-scale epidemiological surveys of the population,because the standardized asthma questionnaire has the characteristics of good cost-effectiveness and high response rate,and the results are also feasible for comparison between different populations or regions.There are currently four asthma epidemiological surveys in the world,including the European Community Respiratory Health Survey(ECRHS),the International Study of Asthma and Allergies in Childhood(ISAAC),the International Study of Wheezing in Infants(EISL)and World Health Survey(WHS).The above research results were also important data source for estimating the global prevalence of asthma in the Global Burden of Disease Study(GBD).In China,several national surveys were conducted on the prevalence of asthma in children and adults,but the reported prevalence of asthma was not comparable with other countries because clinical diagnostic criteria for asthma were frequently used to define asthma in these previous studies.The China Pulmonary Health(CPH)study was a national cross-sectional study that enrolled a nationally representative sample of Chinese adults aged 20 years or older,using the asthma questionnaire derived from ECRHS,we reported that the prevalence of asthma with wheezing in Chinese adults was 4.2%,representing 45.7 million adult asthmatics.However,it should be realized that these data did not include people under the age of 20 years or those with atypical asthmatic symptoms.In addition,the study shows that asthma is largely under-diagnosed and undertreated in China,and these findings call for national efforts to improve the prevention,detection and treatment of asthma in China.