成人早发性和迟发性哮喘的临床和功能差异：基于人群的塔斯马尼亚健康纵向研究
2016/08/31
摘要
背景：早发性和迟发性成人哮喘之间的差异采用前瞻性数据没有得到全面的描述。
目的：一项纵向队列研究中描述早发性和迟发性哮喘之间的差异。
方法：塔斯马尼亚纵向健康研究（TAHS）是一个以人群为基础的队列。呼吸病史和肺活量1968时第一次测定，当时受试者的年龄是7岁（n = 8583）。从2002年到2005年对队列进行了跟踪和重新审视（n = 5729响应），获得了一个富含哮喘和支气管炎患者、时龄44岁的临床研究样本（n = 1389）。
结果：整个TAHS队列中，7.7%（95% CI 6.6% to 9%）有早发性哮喘、7.8%（95% CI 6.4% to 9.4%）有迟发性哮喘。过敏和疾病家族史在早发性哮喘更为常见，而女性、当前正在吸烟和较低的社会经济地位在迟发性哮喘中更为常见。对肺功能的影响，早发性哮喘患者明显大于迟发性哮喘（平均差支气管扩张剂之前（BD）FEV1/FVC- 2.8% 预测（--5.3到--0.3）；支气管扩张剂之后 - 2.6%预测(-5.0 to -0.1)。然而，哮喘严重程度和哮喘得分不同群体之间并没有显著差别。哮喘与吸烟之间的相互作用被确定，并且被发现与成人迟发性哮喘更 有关。这种相互作用在成人早发性疾病中并不明显。
结论：早发性和迟发性成人哮喘在中年人群中普遍存在。主要表型差异在于发病年龄；而两者都有类似的临床表现，早发性哮喘对成人肺功能的影响大于迟发性哮喘。
（杨冬 审校）
Thorax. 2016 Jun 14.pii:thoraxjnl-2015-208183.doi:10.1136/thoraxjnl-2015-208183. [Epub ahead of print]
Clinical and functional differences between early-onset and late-onset adult asthma: a population-based Tasmanian Longitudinal Health Study.
Tan DJ1, Walters EH1, Perret JL2, Burgess JA2, Johns DP3, Lowe AJ4, Lodge CJ2, Hayati Rezvan P5, Simpson JA5, Morrison S6, Thompson BR7,Thomas PS8, Feather I9, Giles GG10, Hopper JL2, Abramson MJ11, Matheson MC2, Dharmage SC4.
Author information
Abstract
BACKGROUND:Differences between early-onset and late-onset adult asthma have not been comprehensively described using prospective data.
AIMS:Tocharacterisethedifferences between early-onset and late-onset asthma in a longitudinal cohort study.
METHODS:The Tasmanian Longitudinal Health Study (TAHS) is a population-based cohort. Respiratory histories and spirometry were first performed in 1968 when participants were aged 7 (n=8583). The cohort was traced and resurveyed from 2002 to 2005 (n=5729 responses) and a sample, enriched for asthma and bronchitis participated in a clinical study when aged 44 (n=1389).
RESULTS:Of the entire TAHS cohort, 7.7% (95% CI 6.6% to 9.0%) had early-onset and 7.8% (95% CI 6.4% to 9.4%) late-onset asthma. Atopy and family history were more common in early-onset asthma while female gender, current smoking and low socioeconomic status were more common in late-onset asthma. The impact on lung function of early-onset asthma was significantly greater than for late-onset asthma (mean difference prebronchodilator (BD) FEV1/FVC -2.8% predicted (-5.3 to -0.3); post-BD FEV1FVC -2.6% predicted (-5.0 to -0.1)). However, asthmaseverity and asthma score did not significantly differ between groups. An interaction between asthma and smoking was identified and found to be associated with greater fixed airflow obstruction in adults with late-onset asthma. This interaction was not evident in adults with early-onset disease.
CONCLUSIONS:Early-onset and late-onset adult asthma are equally prevalent in the middle-aged population. Major phenotypic differences occur with asthma age-of-onset; while both share similar clinical manifestations, the impact on adult lung function of early-onset asthma is greater than for late-onset asthma.
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KEYWORDS:Asthma Epidemiology; Respiratory Measurement
Thorax. 2016 Jun 14.pii:thoraxjnl-2015-208183.doi:10.1136/thoraxjnl-2015-208183. [Epub ahead of print]
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低分子量药物比高分子量药物会导致更严重的哮喘吗？
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