儿童和青少年严重哮喘：一项纵向研究
2020/02/11
摘要
背景：与儿童哮喘相关的发病率和死亡率主要由儿童严重哮喘引起。然而，尚无明确纵向研究表明随着年龄的增长严重哮喘是否可以缓解。
目的：前瞻性地研究特征良好的重度哮喘儿童在青春期时哮喘是否可以缓解。
方法：详细的问卷调查、过敏试验和肺功能试验对哮喘患儿进行基线评估，每年进行一次评估，为期3年。每年根据美国胸科学会/欧洲呼吸学会指南评估严重哮喘儿童人群数量，并且重新评估受试者分类。
结果：111名（59%）儿童患有严重哮喘。符合严重哮喘标准的比例逐年下降。3年后，只有30%的受试者符合严重哮喘的标准（与入组相比P<0.001）。受试者在大多数严重程度指标上都有改善，包括症状评分、急性加重次数和控制用药次数，但肺功能并没有改善。令人惊讶的是，男孩和女孩同样有可能哮喘缓解（33%对29%）。对于外周嗜酸性粒细胞计数大于436个/ml的患者，严重哮喘缓解的OR值为2.75（95%CI，1.02-7.43）。
结论：对这一哮喘特征良好的队列的纵向分析发现，有一半严重哮喘儿童在3年后得到缓解；符合严重哮喘标准的比例逐步下降。令人惊讶的是，在男性和女性受试者中，哮喘的严重程度同样下降。外周嗜酸性粒细胞增多可预测严重哮喘缓解。这些数据对于在这些人群中规划临床试验将十分重要。
Severe asthma during childhood and adolescence: A longitudinal study.
Ross KR; Gupta R; DeBoer MD; Zein J; Phillips BR; Mauger DT; Li C; Myers RE; Phipatanakul W; Fitzpatrick AM; Ly NP; Bacharier LB; Jackson DJ; Celedon JC; Larkin A; Israel E; Levy B; Fahy JV; Castro M; Bleecker ER; Meyers D; Moore WC; Wenzel SE; Jarjour NN; Erzurum SC; Teague WG; Gaston B.
Journal of Allergy & Clinical Immunology. 145(1):140-146e9, January 2020.
Abstract:
Background: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma.
Objective: We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence.
Methods: Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 years. The population was enriched for children with severe asthma, as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was reassessed annually.
Results: At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P < .001 compared with enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations, and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/muL.
Conclusions: In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.
背景：与儿童哮喘相关的发病率和死亡率主要由儿童严重哮喘引起。然而，尚无明确纵向研究表明随着年龄的增长严重哮喘是否可以缓解。
目的：前瞻性地研究特征良好的重度哮喘儿童在青春期时哮喘是否可以缓解。
方法：详细的问卷调查、过敏试验和肺功能试验对哮喘患儿进行基线评估，每年进行一次评估，为期3年。每年根据美国胸科学会/欧洲呼吸学会指南评估严重哮喘儿童人群数量，并且重新评估受试者分类。
结果：111名（59%）儿童患有严重哮喘。符合严重哮喘标准的比例逐年下降。3年后，只有30%的受试者符合严重哮喘的标准（与入组相比P<0.001）。受试者在大多数严重程度指标上都有改善，包括症状评分、急性加重次数和控制用药次数，但肺功能并没有改善。令人惊讶的是，男孩和女孩同样有可能哮喘缓解（33%对29%）。对于外周嗜酸性粒细胞计数大于436个/ml的患者，严重哮喘缓解的OR值为2.75（95%CI，1.02-7.43）。
结论：对这一哮喘特征良好的队列的纵向分析发现，有一半严重哮喘儿童在3年后得到缓解；符合严重哮喘标准的比例逐步下降。令人惊讶的是，在男性和女性受试者中，哮喘的严重程度同样下降。外周嗜酸性粒细胞增多可预测严重哮喘缓解。这些数据对于在这些人群中规划临床试验将十分重要。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Journal of Allergy & Clinical Immunology. 145(1):140-146e9, January 2020.)
(Journal of Allergy & Clinical Immunology. 145(1):140-146e9, January 2020.)
Severe asthma during childhood and adolescence: A longitudinal study.
Ross KR; Gupta R; DeBoer MD; Zein J; Phillips BR; Mauger DT; Li C; Myers RE; Phipatanakul W; Fitzpatrick AM; Ly NP; Bacharier LB; Jackson DJ; Celedon JC; Larkin A; Israel E; Levy B; Fahy JV; Castro M; Bleecker ER; Meyers D; Moore WC; Wenzel SE; Jarjour NN; Erzurum SC; Teague WG; Gaston B.
Journal of Allergy & Clinical Immunology. 145(1):140-146e9, January 2020.
Abstract:
Background: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma.
Objective: We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence.
Methods: Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 years. The population was enriched for children with severe asthma, as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was reassessed annually.
Results: At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P < .001 compared with enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations, and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/muL.
Conclusions: In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.
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