哮喘联盟

   摘要
   背景：虽然原因不明，但是肥胖患儿报道的哮喘症状往往更严重。哮喘和肥胖都与胃食管反流症状(GORS)独立相关。找出肥胖是否对GORS和哮喘之间的关系存在影响将有助于阐明肥胖-哮喘表型。
   目的：延续我们既往的工作去探索GORS和哮喘表型之间的联系程度。
   方法：我们对10-17岁患有持续性早发哮喘的，瘦的(20%-65% 体重指数, BMI)和肥胖的(≥95% BMI) 的孩子进行了一个横断面研究。受试者均提供了人口统计学数据，GORS和哮喘问卷以及肺功能数据。我们试图通过多变量线性和逻辑回归分析来找出体重、GORS和哮喘结局之间的联系。研究结果在另一个有特征明显的哮喘儿童队列中进行了重复。
   结果：肥胖儿童报道复杂的GORS的几率要高七倍(OR=7.7, 95% CI 1.9 -31.0, 交互p 值=.004)。哮喘症状与肥胖患者GORS的评分密切相关(r=0.815, p<0.0001)，但是在瘦的患者中却没有这种关系(r=0.291, p=0.200; 交互p 值=0.003)。GORS评分更高的孩子FEV1占预计值百分比更高，(p=0.003)气道抵抗更低(R10, p=0.025)，气道反应性改善(X10, p=0.005)但是哮喘明显控制得更差(哮喘控制问卷, p=0.007)。在重复队列中观察到与肥胖孩子相比瘦的孩子的GORS和哮喘症状之间存在明显但是较弱的关联。
   结论：肥胖孩子中，GORS常常与的哮喘症状联系在一起。在那些报道胃食管反流和并有症状哮喘的孩子中测得的肺功能更好，这说明将GORS错误当成归类为哮喘症状，可能是造成肥胖儿童哮喘症状严重的原因。

 

（苏欣 审校）
Thorax. 2016 Mar;71(3):238-46. doi: 10.1136/thoraxjnl-2015-207662. Epub 2016 Feb 1.


 

Gastro-oesophageal reflux and worse asthma control in obese children: a case of symptom misattribution?
 

Lang JE1, Hossain J2, Holbrook JT3, Teague WG4, Gold BD5, Wise RA6, Lima JJ7.
 

Abstract
BACKGROUND:Obese children for unknown reasons report greater asthma symptoms. Asthma and obesity both independently associate with gastro-oesophageal reflux symptoms (GORS). Determining if obesity affects the link between GORS and asthma will help elucidate the obese-asthma phenotype.
OBJECTIVE:Extend our previous work to determine the degree of associations between the GORS and asthma phenotype.
METHODS:We conducted a cross-sectional study of lean (20%-65% body mass index, BMI) and obese (≥95% BMI) children aged 10-17 years old with persistent, early-onset asthma. Participants contributed demographics, GORS and asthma questionnaires and lung function data. We determined associations between weight status, GORS and asthma outcomes using multivariable linear and logistic regression. Findings were replicated in a second well-characterised cohort of asthmatic children.
RESULTS:Obese children had seven times higher odds of reporting multiple GORS (OR=7.7, 95% CI 1.9 to 31.0, interaction p value=.004). Asthmasymptoms were closely associated with GORS scores in obese patients (r=0.815, p<0.0001) but not in leans (r=0.291, p=0.200; interaction p value=0.003). Higher GORS scores associated with higher FEV1-per cent predicted (p=0.003), lower airway resistance (R10, p=0.025), improved airway reactance (X10, p=0.005) but significantly worse asthma control (Asthma Control Questionnaire, p=0.007). A significant but weaker association between GORS and asthma symptoms was seen in leans compared with obese in the replicate cohort.
CONCLUSION:GORS are more likely to associate with asthma symptoms in obese children. Better lung function among children reporting gastro-oesophageal reflux and asthma symptoms suggests that misattribution of GORS to asthma may be a contributing mechanism to excess asthmasymptoms in obese children.
 

Thorax. 2016 Mar;71(3):238-46. doi: 10.1136/thoraxjnl-2015-207662. Epub 2016 Feb 1.