儿童哮喘严重程度的相关因素：来自法国COBRAPed队列的数据
2021/01/28
摘要
背景：儿童重症哮喘是一种复杂的异质性疾病，给儿童带来了相当大的负担。然而，影响哮喘严重程度的因素少有描述，其可能因年龄而异。
目的：探讨重度反复喘息学龄前儿童与重症哮喘学龄儿童哮喘严重程度的相关因素是否存在差异。
患者和方法：对来自法国多中心前瞻性观察队列的数据进行分析，队列患者包括重度、非重度反复喘息的学龄前（3-6岁）儿童和重症、非重症哮喘的学龄期（7-11岁）儿童。
结果：131名学龄前儿童（92名重度反复喘息和49名非重度反复喘息患者）和207名学龄儿童（92名重症哮喘和115名非重症哮喘患者）。在单变量和多变量分析中，与非重度反复喘息患者相比，重度反复喘息患者与二手烟暴露（多变量分析，OR[95%CI]，29.8[3.57-3910]）和家中霉菌/湿气暴露（多变量分析：OR[95%CI]，4.22[1.25-18.2]）相关。学龄期，重症哮喘患儿的特应性皮炎和食物过敏史比非重症哮喘患儿更常见。多变量分析证实重症哮喘与食物过敏史有关（OR:5.01[2.23-11.9]）。
结论：影响哮喘严重程度的因素可能因年龄而异。在患有重度反复喘息的学龄前儿童中，二手烟和接触霉菌是主要的危险因素，而学龄期的重症哮喘主要与过敏性疾病有关。
Factors associated with asthma severity in children: data from the French COBRAPed Cohort.
Guillaume Lezmi, Stéphanie Lejeune, Isabelle Pin, Sylvain Blanchon, Naïm Bouazza, Valérie Jolaine, Christophe Marguet, Véronique Houdoin, Patrick Berger, Michael Fayon, Jean-Christophe Dubus, Philippe Reix, Mathieu Pellan, Jacques Brouard, Raphael Chiron, Lisa Giovannini-Chami, Antoine Deschildre, Jacques de Blic, COBRAPed Study Group.
Abstract
BACKGROUND:Severe asthma (SA) in children is a complex, heterogeneous disease, associated with a considerable burden in children. However, factors influencing asthma severity are poorly described and may differ according to age.
OBJECTIVE:To determine whether factors associated with asthma severity differ between preschoolers with severe recurrent wheeze (SRW) and school-age children with SA.
Patients and methods:Data from the French multicenter prospective observational cohort of preschool (3-6 years) children with SRW and non-severe recurrent wheeze (NSRW) and school-age (7-11 years) children with SA and non-severe asthma (NSA) (COBRAPed) were analyzed.
RESULTS:131 preschool children (92 SRW and 49 NSRW) and 207 school-age children (92 SA and 115 NSA) were included. In both univariable and multi-variable analysis, SRW was associated with second-hand smoke exposure (multi-variable analysis, OR [95%CI], 29.8 [3.57-3910]), and exposure to mold/dampness at home (multi-variable analysis: OR [95%CI], 4.22 [1.25-18.2]) compared with NSRW. At school-age, history of atopic dermatitis and food allergy were more frequent in children with SA than in those with NSA. Multi-variable analysis confirmed that SA was associated with a history of food allergy (OR: 5.01 [2.23-11.9]).
CONCLUSIONS:Our data suggest that factors influencing asthma severity may differ according to age. In preschool children with SRW, second-hand smoke and exposure to mold are predominant, whereas associated allergic disorders are mainly involved in SA at school age.
背景：儿童重症哮喘是一种复杂的异质性疾病，给儿童带来了相当大的负担。然而，影响哮喘严重程度的因素少有描述，其可能因年龄而异。
目的：探讨重度反复喘息学龄前儿童与重症哮喘学龄儿童哮喘严重程度的相关因素是否存在差异。
患者和方法：对来自法国多中心前瞻性观察队列的数据进行分析，队列患者包括重度、非重度反复喘息的学龄前（3-6岁）儿童和重症、非重症哮喘的学龄期（7-11岁）儿童。
结果：131名学龄前儿童（92名重度反复喘息和49名非重度反复喘息患者）和207名学龄儿童（92名重症哮喘和115名非重症哮喘患者）。在单变量和多变量分析中，与非重度反复喘息患者相比，重度反复喘息患者与二手烟暴露（多变量分析，OR[95%CI]，29.8[3.57-3910]）和家中霉菌/湿气暴露（多变量分析：OR[95%CI]，4.22[1.25-18.2]）相关。学龄期，重症哮喘患儿的特应性皮炎和食物过敏史比非重症哮喘患儿更常见。多变量分析证实重症哮喘与食物过敏史有关（OR:5.01[2.23-11.9]）。
结论：影响哮喘严重程度的因素可能因年龄而异。在患有重度反复喘息的学龄前儿童中，二手烟和接触霉菌是主要的危险因素，而学龄期的重症哮喘主要与过敏性疾病有关。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2020 Dec 24;S2213-2198(20)31359-3. doi: 10.1016/j.jaip.2020.12.027.)
(J Allergy Clin Immunol Pract. 2020 Dec 24;S2213-2198(20)31359-3. doi: 10.1016/j.jaip.2020.12.027.)
Factors associated with asthma severity in children: data from the French COBRAPed Cohort.
Guillaume Lezmi, Stéphanie Lejeune, Isabelle Pin, Sylvain Blanchon, Naïm Bouazza, Valérie Jolaine, Christophe Marguet, Véronique Houdoin, Patrick Berger, Michael Fayon, Jean-Christophe Dubus, Philippe Reix, Mathieu Pellan, Jacques Brouard, Raphael Chiron, Lisa Giovannini-Chami, Antoine Deschildre, Jacques de Blic, COBRAPed Study Group.
Abstract
BACKGROUND:Severe asthma (SA) in children is a complex, heterogeneous disease, associated with a considerable burden in children. However, factors influencing asthma severity are poorly described and may differ according to age.
OBJECTIVE:To determine whether factors associated with asthma severity differ between preschoolers with severe recurrent wheeze (SRW) and school-age children with SA.
Patients and methods:Data from the French multicenter prospective observational cohort of preschool (3-6 years) children with SRW and non-severe recurrent wheeze (NSRW) and school-age (7-11 years) children with SA and non-severe asthma (NSA) (COBRAPed) were analyzed.
RESULTS:131 preschool children (92 SRW and 49 NSRW) and 207 school-age children (92 SA and 115 NSA) were included. In both univariable and multi-variable analysis, SRW was associated with second-hand smoke exposure (multi-variable analysis, OR [95%CI], 29.8 [3.57-3910]), and exposure to mold/dampness at home (multi-variable analysis: OR [95%CI], 4.22 [1.25-18.2]) compared with NSRW. At school-age, history of atopic dermatitis and food allergy were more frequent in children with SA than in those with NSA. Multi-variable analysis confirmed that SA was associated with a history of food allergy (OR: 5.01 [2.23-11.9]).
CONCLUSIONS:Our data suggest that factors influencing asthma severity may differ according to age. In preschool children with SRW, second-hand smoke and exposure to mold are predominant, whereas associated allergic disorders are mainly involved in SA at school age.
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因哮喘住院患者再入院和死亡的风险
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