儿童和青春期严重哮喘：一项纵向研究
2020/12/17
摘要
背景：与儿童哮喘相关的发病率和死亡率不成比例地由患者有严重哮喘的儿童驱动。然而从纵向研究中还不知道儿童是否不再患有重症哮喘。
目的：我们试图前瞻性地研究患者有严重哮喘的特征良好的儿童在青春期是否会超过他们的哮喘。
方法：哮喘儿童在基线时使用详细的问卷、过敏试验和肺功能试验进行评估，并在3年内每年进行重新评估。根据美国胸科学会/欧洲呼吸学会指南的评估，对重症哮喘儿童的人群进行了富集，并每年重新评估受试者分类。
结果：基线时，111名（59%）儿童患有严重哮喘。每年，符合严重哮喘标准的比例都在下降。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）。受试者经历了大多数严重程度指数的改善，包括症状评分、恶化和控制药物需求，但没有肺功能。令人惊讶的是，男孩和女孩同样有可能改善哮喘（33%和29%）。对于那些外周血嗜酸性粒细胞计数大于2.75ul个细胞/ul的患者，支持重症哮喘消退的比值比为2.75（95%CI，1.02-7.43）。
结论：在这一特征明确的队列的纵向分析中，一半的重度哮喘儿童在3年后不再患有重症哮喘；符合重症哮喘标准的比例逐步下降。令人惊讶的是，哮喘严重程度在男性和女性受试者中同样降低。外周血嗜酸性粒细胞增多预测预后情况。这些数据对于在该人群中规划临床试验将是重要的。
Severe asthma during childhood and adolescence: A longitudinal study
Kristie R Ross, Ritika Gupta , Mark D DeBoer , Joe Zein , Brenda R Phillips , David T Mauger , Chun Li , Ross E Myers , Wanda Phipatanakul , Anne M Fitzpatrick , Ngoc P Ly , Leonard B Bacharier , Daniel J Jackson , Juan C Celedón , Allyson Larkin , Elliot Israel , Bruce Levy , John V Fahy , Mario Castro , Eugene R Bleecker , Deborah Meyers , Wendy C Moore , Sally E Wenzel , Nizar N Jarjour , Serpil C Erzurum , W Gerald Teague , Benjamin Gaston
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/μL.
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不成比例地由患者有严重哮喘的儿童驱动。然而从纵向研究中还不知道儿童是否不再患有重症哮喘。
目的：我们试图前瞻性地研究患者有严重哮喘的特征良好的儿童在青春期是否会超过他们的哮喘。
方法：哮喘儿童在基线时使用详细的问卷、过敏试验和肺功能试验进行评估，并在3年内每年进行重新评估。根据美国胸科学会/欧洲呼吸学会指南的评估，对重症哮喘儿童的人群进行了富集，并每年重新评估受试者分类。
结果：基线时，111名（59%）儿童患有严重哮喘。每年，符合严重哮喘标准的比例都在下降。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）。受试者经历了大多数严重程度指数的改善，包括症状评分、恶化和控制药物需求，但没有肺功能。令人惊讶的是，男孩和女孩同样有可能改善哮喘（33%和29%）。对于那些外周血嗜酸性粒细胞计数大于2.75ul个细胞/ul的患者，支持重症哮喘消退的比值比为2.75（95%CI，1.02-7.43）。
结论：在这一特征明确的队列的纵向分析中，一半的重度哮喘儿童在3年后不再患有重症哮喘；符合重症哮喘标准的比例逐步下降。令人惊讶的是，哮喘严重程度在男性和女性受试者中同样降低。外周血嗜酸性粒细胞增多预测预后情况。这些数据对于在该人群中规划临床试验将是重要的。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2020 Jan;145(1):140-146.e9.doi: 10.1016/j.jaci.2019.09.030. Epub 2019 Oct 14.)
(J Allergy Clin Immunol. 2020 Jan;145(1):140-146.e9.doi: 10.1016/j.jaci.2019.09.030. Epub 2019 Oct 14.)
Severe asthma during childhood and adolescence: A longitudinal study
Kristie R Ross, Ritika Gupta , Mark D DeBoer , Joe Zein , Brenda R Phillips , David T Mauger , Chun Li , Ross E Myers , Wanda Phipatanakul , Anne M Fitzpatrick , Ngoc P Ly , Leonard B Bacharier , Daniel J Jackson , Juan C Celedón , Allyson Larkin , Elliot Israel , Bruce Levy , John V Fahy , Mario Castro , Eugene R Bleecker , Deborah Meyers , Wendy C Moore , Sally E Wenzel , Nizar N Jarjour , Serpil C Erzurum , W Gerald Teague , Benjamin Gaston
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/μL.
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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重症哮喘患者的辣椒素敏感性增加与临床结果恶化相关
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支气管哮喘的新冠肺炎易感性
