肥胖是否会增加哮喘病人的气道感染？
2018/10/24
摘要
背景：由于疾病恶化前大多会出现气道感染，所以更好地了解哮喘患者气道感染或与气道感染相关的疾病恶化的危险因素是公共卫生迫切的需要。哮喘患者中的肥胖与较差的哮喘控制相关及医疗保健利用相关，但其在气道感染风险上的作用并不清楚。
目的：我们的目的是研究BMI分类与成人和哮喘儿童自我报告的气道感染风险和相关哮喘发病率之间的关系。
方法：包括747名儿童及1287名成人的五大哮喘试验的出院后分析比较分别定义为偏瘦、超重以及肥胖BMI分类。基本结果是合并气道感染的来访者的概率。次级结果包括上气道感染的严重程度、全身激素的使用以及健康中心的就诊情况。
这项涉及747名儿童和1287名成年人的5项大型哮喘试验的事后分析比较了BMI分类，根据年龄校正的体重指数（BMI）和BMI百分位数定义为偏瘦，超重和肥胖。初级结果是气道感染者的就诊率。次级哮喘结果包括上呼吸道感染（URI）严重程度，全身激素的使用情况以及医疗保健之间的联系。
结果：儿童合并气道感染的概率是成人的1.4倍（95%可信区间1.27-1.56）。在所有参与者中，BMI分类不影响气道感染的就诊率。在儿童中BMI分类并不影响上气道感染的严重程度、全因哮喘事件或与气道感染相关哮喘事件。然而，在成年人中较高的BMI分类与中重度气道感染的增加相关（p = 0.02）。BMI分级较高的成年人需要全身激素及健康保健的全因和气道感染相关哮喘急性发作的发生率也有所增加。
结论：BMI与儿童或成人呼吸道感染风险未见明显相关性。仅在成人中，肥胖与呼吸道感染严重性及全因或气道感染相关哮喘死亡率具有相关性。
Does Obesity Increase Respiratory Tract Infections in Patients with Asthma?
Tang M, Henderson RJ
Abstract
BACKGROUND:Since respiratory tract infections (RTIs) precede most exacerbations, better understanding of the risk factors of RTIs and RTI-associated exacerbations in patients with asthma is a pressing public health need. Obesity in patients with asthma is associated with worse asthma control and higher asthma-associated healthcare utilization but its effect on RTI risk is unknown.
OBJECTIVE:We aimed to study the association of BMI classification on the risk of self-reported RTIs and related asthma morbidity among adults and children with asthma.
METHODS:This post-hoc analysis of five large asthma trials involving 747 children and 1287 adults compared BMI classification, defined as lean, overweight and obese based on age-appropriate body mass index (BMI) and BMI-percentile conventions. The primary outcome was rate of visits with RTIs. Secondary asthma outcomes included upper respiratory infection (URI) severity, systemic steroid use, and healthcare contact.
RESULTS:Children had 1.4 times the rate of RTI compared to adults (95% CI 1.27-1.56). In all participants, BMI classification did not affect the rate of visits with RTI. In children, BMI classification did not affect URI severity, all-cause asthma events or RTI-associated asthma events. However, in adults, higher BMI classification was associated with an increase in moderate/severe URI (p=0.02). Adults with higher BMI classification also had increased rates of all-cause and RTI-associated asthma exacerbations requiring systemic steroids and healthcare contact.
CONCLUSIONS:BMI classification was not associated with increased risk of RTIs in children or adults. In adults only, obesity was associated with increased URI severity and all-cause and RTI-associated asthma morbidity.
背景：由于疾病恶化前大多会出现气道感染，所以更好地了解哮喘患者气道感染或与气道感染相关的疾病恶化的危险因素是公共卫生迫切的需要。哮喘患者中的肥胖与较差的哮喘控制相关及医疗保健利用相关，但其在气道感染风险上的作用并不清楚。
目的：我们的目的是研究BMI分类与成人和哮喘儿童自我报告的气道感染风险和相关哮喘发病率之间的关系。
方法：包括747名儿童及1287名成人的五大哮喘试验的出院后分析比较分别定义为偏瘦、超重以及肥胖BMI分类。基本结果是合并气道感染的来访者的概率。次级结果包括上气道感染的严重程度、全身激素的使用以及健康中心的就诊情况。
这项涉及747名儿童和1287名成年人的5项大型哮喘试验的事后分析比较了BMI分类，根据年龄校正的体重指数（BMI）和BMI百分位数定义为偏瘦，超重和肥胖。初级结果是气道感染者的就诊率。次级哮喘结果包括上呼吸道感染（URI）严重程度，全身激素的使用情况以及医疗保健之间的联系。
结果：儿童合并气道感染的概率是成人的1.4倍（95%可信区间1.27-1.56）。在所有参与者中，BMI分类不影响气道感染的就诊率。在儿童中BMI分类并不影响上气道感染的严重程度、全因哮喘事件或与气道感染相关哮喘事件。然而，在成年人中较高的BMI分类与中重度气道感染的增加相关（p = 0.02）。BMI分级较高的成年人需要全身激素及健康保健的全因和气道感染相关哮喘急性发作的发生率也有所增加。
结论：BMI与儿童或成人呼吸道感染风险未见明显相关性。仅在成人中，肥胖与呼吸道感染严重性及全因或气道感染相关哮喘死亡率具有相关性。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（J Allergy Clin Immunol Pract.2018 Oct 9.）
（J Allergy Clin Immunol Pract.2018 Oct 9.）
Does Obesity Increase Respiratory Tract Infections in Patients with Asthma?
Tang M, Henderson RJ
Abstract
BACKGROUND:Since respiratory tract infections (RTIs) precede most exacerbations, better understanding of the risk factors of RTIs and RTI-associated exacerbations in patients with asthma is a pressing public health need. Obesity in patients with asthma is associated with worse asthma control and higher asthma-associated healthcare utilization but its effect on RTI risk is unknown.
OBJECTIVE:We aimed to study the association of BMI classification on the risk of self-reported RTIs and related asthma morbidity among adults and children with asthma.
METHODS:This post-hoc analysis of five large asthma trials involving 747 children and 1287 adults compared BMI classification, defined as lean, overweight and obese based on age-appropriate body mass index (BMI) and BMI-percentile conventions. The primary outcome was rate of visits with RTIs. Secondary asthma outcomes included upper respiratory infection (URI) severity, systemic steroid use, and healthcare contact.
RESULTS:Children had 1.4 times the rate of RTI compared to adults (95% CI 1.27-1.56). In all participants, BMI classification did not affect the rate of visits with RTI. In children, BMI classification did not affect URI severity, all-cause asthma events or RTI-associated asthma events. However, in adults, higher BMI classification was associated with an increase in moderate/severe URI (p=0.02). Adults with higher BMI classification also had increased rates of all-cause and RTI-associated asthma exacerbations requiring systemic steroids and healthcare contact.
CONCLUSIONS:BMI classification was not associated with increased risk of RTIs in children or adults. In adults only, obesity was associated with increased URI severity and all-cause and RTI-associated asthma morbidity.
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