英国婴幼儿到老年哮喘的发作风险和特征
2017/11/20
摘要
背景：很少有研究调查普遍哮喘人群的特征；大多数集中在严重患者或严重发作。
方法：这项基于人群的队列研究，从2007年4月到2015年9月，使用连接初级和二级医疗机构的电子医疗记录（临床实践研究数据，医院统计）。根据“5岁以下”、“5~17岁 ”、“18~54岁”、“55岁以上”描述了四个年龄组的特点。使用泊松回归评估发作风险因素，包括哮喘严重程度（由英国胸科协会（BTS）逐步进行测量）。
结果:424 326例哮喘患者入组（数量，中位随访时间分别为：“5岁以下”17 320例，1年；“5〜17岁”82 707例，3.3年；“18〜54岁”210 724，4年；“55 岁以上”113 575例，5.1年）。总研究人群中超过60％患有轻度哮喘（BTS步骤1/2）。不同组之间存在差异，包括性别，疾病严重程度和发作方式。55岁以上人群发作比例最高，5至17岁组发作比例最低（每10人年比率（95％CI），“5岁以下”4.27（4.18~4.38），“5至17岁”1.48（1.47〜1.50），“18〜54岁”3.22（3.21〜3.24），“55 岁以上”9.40（9.37〜9.42））。在所有组中，发作率随哮喘的严重程度的增加而增加，调整后的混杂因素包括性别、社会经济状况、吸烟、体重指数、过敏、鼻炎、胃食管反流、焦虑、抑郁和慢性阻塞性肺疾病。
结论：大多数英国哮喘患者为轻度哮喘，在随访期间没有出现哮喘发作。55岁以上哮喘患者轻度哮喘比例最低，发作率最高; 5至18岁哮喘患者正相反。
Exacerbation risk and characterisation of the UK's asthma population from infants to old age
Bloom CI1, Nissen F2, Douglas IJ2, Smeeth L2, Cullinan P1, Quint JK1.
Abstract
BACKGROUND:Few studies have examined the characteristics of a general asthma population; most have focused on more severe patients or severe exacerbations.
METHODS:This population-based cohort study, from April 2007 to September 2015, used linked primary and secondary care electronic healthcare records (Clinical Practice Research Datalink, Hospital Episode Statistics). Characteristics of four age cohorts, 'Under 5s', '5 to 17s', '18 to 54s', '55+', were described. Exacerbation risk factors, including asthma severity (measured by the British Thoracic Society (BTS) stepwise approach), were assessed using Poisson regression.
RESULTS:A 424 326 patients with current asthma were eligible (n, median follow-up: 'Under 5s'=17 320, 1 year; '5 to 17s'=82 707, 3.3 years; '18 to 54s'=210 724, 4 years; '55+'=113 575, 5.1 years). Over 60% of the total study population had mild asthma (BTS steps 1/2). There were differences between the cohort's characteristics, including by gender, disease severity and exacerbation pattern. The rate of exacerbations was highest in the oldest cohort and lowest in the '5 to 17s' cohort (rate per 10 person-years (95% CI), 'Under 5s'=4.27 (4.18 to 4.38), '5 to 17s'=1.48 (1.47 to 1.50), '18 to 54s'=3.22 (3.21 to 3.24), '55+'=9.40 (9.37 to 9.42)). In all cohorts, exacerbation rates increased with increasing asthma severity, after adjusting for confounders including gender, socioeconomic status, smoking, body mass index, atopy, rhinitis, gastro-oesophageal reflux, anxiety, depression and COPD.
CONCLUSIONS:The majority of UK patients with asthma had mild asthma and did not experience an exacerbation during follow-up. Patients aged ≥55 years had the lowest proportion with mild asthma and highest rate of exacerbations; the opposite was found in patients aged between 5 and 18 years.
背景：很少有研究调查普遍哮喘人群的特征；大多数集中在严重患者或严重发作。
方法：这项基于人群的队列研究，从2007年4月到2015年9月，使用连接初级和二级医疗机构的电子医疗记录（临床实践研究数据，医院统计）。根据“5岁以下”、“5~17岁 ”、“18~54岁”、“55岁以上”描述了四个年龄组的特点。使用泊松回归评估发作风险因素，包括哮喘严重程度（由英国胸科协会（BTS）逐步进行测量）。
结果:424 326例哮喘患者入组（数量，中位随访时间分别为：“5岁以下”17 320例，1年；“5〜17岁”82 707例，3.3年；“18〜54岁”210 724，4年；“55 岁以上”113 575例，5.1年）。总研究人群中超过60％患有轻度哮喘（BTS步骤1/2）。不同组之间存在差异，包括性别，疾病严重程度和发作方式。55岁以上人群发作比例最高，5至17岁组发作比例最低（每10人年比率（95％CI），“5岁以下”4.27（4.18~4.38），“5至17岁”1.48（1.47〜1.50），“18〜54岁”3.22（3.21〜3.24），“55 岁以上”9.40（9.37〜9.42））。在所有组中，发作率随哮喘的严重程度的增加而增加，调整后的混杂因素包括性别、社会经济状况、吸烟、体重指数、过敏、鼻炎、胃食管反流、焦虑、抑郁和慢性阻塞性肺疾病。
结论：大多数英国哮喘患者为轻度哮喘，在随访期间没有出现哮喘发作。55岁以上哮喘患者轻度哮喘比例最低，发作率最高; 5至18岁哮喘患者正相反。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Thorax.2017Oct26.pii:thoraxjnl-2017-210650.doi:10.1136/thoraxjnl-2017-210650. [Epub ahead of print])
(Thorax.2017Oct26.pii:thoraxjnl-2017-210650.doi:10.1136/thoraxjnl-2017-210650. [Epub ahead of print])
Exacerbation risk and characterisation of the UK's asthma population from infants to old age
Bloom CI1, Nissen F2, Douglas IJ2, Smeeth L2, Cullinan P1, Quint JK1.
Abstract
BACKGROUND:Few studies have examined the characteristics of a general asthma population; most have focused on more severe patients or severe exacerbations.
METHODS:This population-based cohort study, from April 2007 to September 2015, used linked primary and secondary care electronic healthcare records (Clinical Practice Research Datalink, Hospital Episode Statistics). Characteristics of four age cohorts, 'Under 5s', '5 to 17s', '18 to 54s', '55+', were described. Exacerbation risk factors, including asthma severity (measured by the British Thoracic Society (BTS) stepwise approach), were assessed using Poisson regression.
RESULTS:A 424 326 patients with current asthma were eligible (n, median follow-up: 'Under 5s'=17 320, 1 year; '5 to 17s'=82 707, 3.3 years; '18 to 54s'=210 724, 4 years; '55+'=113 575, 5.1 years). Over 60% of the total study population had mild asthma (BTS steps 1/2). There were differences between the cohort's characteristics, including by gender, disease severity and exacerbation pattern. The rate of exacerbations was highest in the oldest cohort and lowest in the '5 to 17s' cohort (rate per 10 person-years (95% CI), 'Under 5s'=4.27 (4.18 to 4.38), '5 to 17s'=1.48 (1.47 to 1.50), '18 to 54s'=3.22 (3.21 to 3.24), '55+'=9.40 (9.37 to 9.42)). In all cohorts, exacerbation rates increased with increasing asthma severity, after adjusting for confounders including gender, socioeconomic status, smoking, body mass index, atopy, rhinitis, gastro-oesophageal reflux, anxiety, depression and COPD.
CONCLUSIONS:The majority of UK patients with asthma had mild asthma and did not experience an exacerbation during follow-up. Patients aged ≥55 years had the lowest proportion with mild asthma and highest rate of exacerbations; the opposite was found in patients aged between 5 and 18 years.
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对宠物的敏感和接触：对美国人群哮喘发病率的影响
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哮喘的频繁或罕见发作的比较特征：回顾性和前瞻性事件的纵向研究
