在中年罹患哮喘极大促进吸烟发展成慢性支气管炎：一项前瞻性的以人群为基础的研究
2016/10/09
摘要
背景和目的：个人吸烟被广泛认为是成人慢性支气管炎（CB）的主要原因，但其它因素，包括目前哮喘对慢性支气管炎的影响知之甚少。我们旨在评估从儿童到中年，其它影响成人慢性支气管炎的独立和相关的影响因素。
方法：以人群为基础的塔斯马尼亚纵向健康研究队列中，出生于1961年的人在1968年完成了呼吸问卷调查和肺活量测定（N = 8583）。37年后，在2004，三分之二的人回复了一个详细的邮政调查（N = 5729），从中建立了中年患慢性支气管炎队列。其中一个样本（N = 1389）的患者，在2006年到2008年间，进行了支气管扩张剂后肺功能测试来评估慢性气流通气受限，从而确定非阻塞和阻塞性的慢性支气管炎。多变量和多因素的回归模型被用来估计相关关系。
结果：中年人中慢性支气管炎的的患病率为6.1%（95%可信区间为5.5，6.8）。中年罹患哮喘或喘息与成人慢性支气管炎独立相关（比值比[OR]：6.2 [ 95%可信区间：4.6，8.4 ]），这一估计显著高于目前至少20包-年的吸烟者（比值比：3 [ 95%可信区间：2.1，4.3 ]）。中年哮喘和吸烟与阻塞性慢性支气管炎均相关，与过敏和非阻塞性慢性支气管炎不同。童年的预测因素包括过敏史（比值比：1.3 [ 95% CI：1.1，1.7]）、目前的哮喘（比值比：1.8 [ 95% CI：1.3，2.7]）、偶发性童年哮喘（比值比：2.3 [ 95% CI：1.4，3.9]）、和父母支气管炎症状（比值比：2.5 [ 95% CI：1.6，4.1]）。
结论：中年罹患哮喘和慢性支气管炎之间的强烈独立的关联表明，这种情况可能比个人吸烟在一般人群中更有影响力。儿童过敏和哮喘的独立相关性，虽然不是儿童支气管炎，作为成人慢性支气管炎的临床预测因子提高了这种负担起源于童年的可能性。
关键词：过敏史；目前哮喘；非阻塞性慢性支气管炎；阻塞性慢性支气管炎；个人吸烟
（杨冬 审校）
IntJChronObstructPulmonDis.2016Aug16;11:1911-20. doi: 10.2147/COPD.S103908. eCollection 2016.
Current asthma contributes as much as smoking to chronic bronchitis in middle age: a prospective population-based study.
Dharmage SC1, Perret JL2, Burgess JA1, Lodge CJ1, Johns DP3, Thomas PS4, Giles GG5, Hopper JL6, Abramson MJ7, Walters EH8, Matheson MC1.
Author information
Abstract
BACKGROUND AND OBJECTIVE:Personal smoking is widely regarded to be the primary cause of chronic bronchitis (CB) in adults, but with limited knowledge of contributions by other factors, including current asthma. We aimed to estimate the independent and relative contributions to adult CB from other potential influences spanning childhood to middle age.
METHODS:The population-based Tasmanian Longitudinal Health Study cohort, people born in 1961, completed respiratory questionnaires and spirometry in 1968 (n=8,583). Thirty-seven years later, in 2004, two-thirds responded to a detailed postal survey (n=5,729), from which the presence of CB was established in middle age. A subsample (n=1,389) underwent postbronchodilator spirometry between 2006 and 2008 for the assessment of chronic airflow limitation, from which nonobstructive and obstructive CB were defined. Multivariable and multinomial logistic regression models were used to estimate relevant associations.
RESULTS:The prevalence of CB in middle age was 6.1% (95% confidence interval [CI]: 5.5, 6.8). Current asthma and/or wheezy breathing in middle age was independently associated with adult CB (odds ratio [OR]: 6.2 [95% CI: 4.6, 8.4]), and this estimate was significantly higher than for current smokers of at least 20 pack-years (OR: 3.0 [95% CI: 2.1, 4.3]). Current asthma and smoking in middle age were similarly associated with obstructive CB, in contrast to the association between allergy and nonobstructive CB. Childhood predictors included allergic history (OR: 1.3 [95% CI: 1.1, 1.7]), current asthma (OR: 1.8 [95% CI: 1.3, 2.7]), "episodic" childhood asthma (OR: 2.3 [95% CI: 1.4, 3.9]), and parental bronchitis symptoms (OR: 2.5 [95% CI: 1.6, 4.1]).
CONCLUSION:The strong independent association between current asthma and CB in middle age suggests that this condition may be even more influential than personal smoking in a general population. The independent associations of childhood allergy and asthma, though not childhood bronchitis, as clinical predictors of adult CB raise the possibility of some of this burden having originated in childhood.
KEYWORDS:allergy history; current asthma; nonobstructive chronic bronchitis; obstructive chronic bronchitis; personal smoking
IntJChronObstructPulmonDis.2016Aug16;11:1911-20. doi: 10.2147/COPD.S103908. eCollection 2016.
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哮喘患者并发症对生产力损失的影响
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慢性鼻窦炎与勃起功能障碍：一项基于人群的研究
