気管支喘息の早期診断基準の提言  [in Japanese] ADVOCATING THE DIAGNOSTIC CRITERIA FOR EARLY STAGE OF ASTHMA  [in Japanese]

【目的】気管支喘息の初発症状は,典型的な症状を呈しないことも多く,診断に時間を要し重症化する例も稀ではない.気管支喘息は,治療の早期介入が重症化・難治化を予防することが判明している.このような背景により,今回,早期診断基準の作成を行った.【方法】発症初期の症状が判明し,気管支喘息と確定診断されている388症例の初発症状および初診時の検査所見を解析した.【結果】発症初期の自覚症状は,咳嗽が79%,喘鳴68%,呼吸困難49%であり,典型的な症状を呈しない症例も15%存在していた.初診時に異常を呈していた検査所見は,気道過敏性亢進(99%),%V_<25>低値(92%),喀痰中好酸球3%以上(82%),%V_<50>低値(77%)の順であった.一方,FEV_<1%>は67%が正常であり,気道可逆性検査の陽性率は約半数と,発症初期での診断には適さないことが判明した.【結語】以上の結果より,気管支喘息の早期診断基準案は,以下の3項目とした.1,発作性の喘鳴ないし呼吸困難ないし咳の反復.2,(1),(2)のいずれかを満たす.(1)気道過敏性陽性(2)A.喀痰好酸球3%以上,または,B.%V_<50>70%以下または%V_<25>50%以下,または,C.気管支拡張薬による症状の改善(咳単独の場合はC).3,1の原因となる他心肺疾患の除外.

Background: In asthmatic patients, first asthmatic symptoms are not often typical. In those cases, it takes long time before asthma diagnosis, and the severities are progressed in some patients. For early intervention, we tried to make the diagnostic criteria for asthma, which are useful to diagnose as early stage of asthma. Methods: Three hundred and eighty eight of asthmatic patients, who were recorded first their symptoms in asthma, were enrolled. Their first symptoms and examinations were analyzed. Results: In first asthmatic symptoms, 79% of patients had cough, 68% patients had wheezing, 49% patients had dyspnoea, and 15% of patients did not have typical asthmatic symptoms in the early stage. The percentages of abnormal in first examinations were 99% in airway hypersensitivity, 92% of low %V_<25>, 82% of eosinophila in sputum and 77% of low %V_<50>. Low FEV_<1%> and reversible airway obstruction were not seen in a lot of patients. Conclusion: We advocate that the diagnostic criteria for early stage of asthma are the following three elements. First criterion is spasmodic cough, wheezing and dyspnoea. Second criterion is airway hypersensitivity, or over 3% of eosinophils in sputum, or under 70% of %V_<50>, or under 50% of %V_<25>, or effect of bronchodilator. Effect of bronchodilator will be required, when the symptom is cough only. Third criterion is the exclusion of other lung and heart diseases.