具有缓解的儿童期哮喘病史的成人肺功能加速下降
2021/10/20
摘要
背景：大量哮喘患儿在成年后出现缓解。虽然这些成年人在晚年经常被诊断为慢性阻塞性肺疾病，但临床缓解的儿童期哮喘对成年后肺功能下降的影响尚不确定。
目的：我们研究了儿童哮喘的临床缓解是否与表面无哮喘的成人的肺功能加速下降有关。
方法：纳入3584名参与者(平均年龄48.1岁，年龄跨度35-65岁)，这些受试者在基线访视时无成人哮喘和其他肺部疾病且肺功能正常。根据自身报告的儿童期哮喘史，将其分为已缓解的儿童期哮喘组（n=121）和健康对照者（n=3463）。在基线和随访时进行肺活量测定。
结果：平均随访时间为5.3年。多元回归分析显示，缓解的儿童期哮喘和吸烟与第1秒用力呼气量(FEV1)和用力肺活量(FVC)的快速下降呈独立相关。此外，吸烟是FEV1/FVC迅速下降的独立预测因素。具有缓解的儿童期哮喘的患者FEV1和FVC年降幅明显高于健康对照组，调整倾向评分后仍具有显著差异。
结论：儿童期哮喘临床缓解史是成人肺功能加速下降的独立危险因素。缓解的儿童期哮喘和吸烟可能会进一步加速阻塞性肺疾病的发展。
Accelerated decline in lung function in adults with a history of remitted childhood asthma
Shinichiro Miura, Hiroshi Iwamoto, Keitaro Omori, Kakuhiro Yamaguchi, Shinjiro Sakamoto, Yasushi Horimasu, Takeshi Masuda, Shintaro Miyamoto, Taku Nakashima, Kazunori Fujitaka, Hironobu Hamada, Akihito Yokoyama, Noboru Hattori
Abstract
BACKGROUND:A significant number of children with asthma show remission in adulthood. Although these adults are often diagnosed with chronic obstructive pulmonary disease in later life, the effect of clinically remitted childhood asthma on the decline in lung function during adulthood is uncertain.
OBJECTIVE:We examined whether clinical remission of childhood asthma was associated with an accelerated decline in lung function in apparently non-asthmatic adults.
METHODS:Here, 3584 participants (mean age, 48.1 years; range, 35-65 years) who did not have adulthood asthma and other lung diseases and had normal lung function at the baseline visit were included. They were categorised as follows: those with remitted childhood asthma (n=121) and healthy controls (n=3463) according to their self-reported childhood asthma history. Spirometry was performed at baseline and follow-up visits.
RESULTS:The mean follow-up time was 5.3 years. Multivariate regression analysis showed that remitted childhood asthma and smoking were independently associated with a rapid decline in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Besides, smoking was an independent predictor of a rapid decline in the FEV1/FVC. The annual decline in FEV1 and FVC was significantly greater in participants with remitted childhood asthma than in healthy controls, and the differences remained significant after adjusting for the propensity score.
CONCLUSION:A history of clinically remitted childhood asthma is an independent risk factor for accelerated decline in lung function in adults. Remitted childhood asthma and smoking may additively accelerate the development of obstructive lung disease.
背景：大量哮喘患儿在成年后出现缓解。虽然这些成年人在晚年经常被诊断为慢性阻塞性肺疾病，但临床缓解的儿童期哮喘对成年后肺功能下降的影响尚不确定。
目的：我们研究了儿童哮喘的临床缓解是否与表面无哮喘的成人的肺功能加速下降有关。
方法：纳入3584名参与者(平均年龄48.1岁，年龄跨度35-65岁)，这些受试者在基线访视时无成人哮喘和其他肺部疾病且肺功能正常。根据自身报告的儿童期哮喘史，将其分为已缓解的儿童期哮喘组（n=121）和健康对照者（n=3463）。在基线和随访时进行肺活量测定。
结果：平均随访时间为5.3年。多元回归分析显示，缓解的儿童期哮喘和吸烟与第1秒用力呼气量(FEV1)和用力肺活量(FVC)的快速下降呈独立相关。此外，吸烟是FEV1/FVC迅速下降的独立预测因素。具有缓解的儿童期哮喘的患者FEV1和FVC年降幅明显高于健康对照组，调整倾向评分后仍具有显著差异。
结论：儿童期哮喘临床缓解史是成人肺功能加速下降的独立危险因素。缓解的儿童期哮喘和吸烟可能会进一步加速阻塞性肺疾病的发展。
(中日友好医院呼吸与危重症医学科 王静茹 摘译 林江涛 审校)
(Eur Respir J. 2021 Sep 29; 2100305.doi: 10.1183/13993003.00305-2021.)
(Eur Respir J. 2021 Sep 29; 2100305.doi: 10.1183/13993003.00305-2021.)
Accelerated decline in lung function in adults with a history of remitted childhood asthma
Shinichiro Miura, Hiroshi Iwamoto, Keitaro Omori, Kakuhiro Yamaguchi, Shinjiro Sakamoto, Yasushi Horimasu, Takeshi Masuda, Shintaro Miyamoto, Taku Nakashima, Kazunori Fujitaka, Hironobu Hamada, Akihito Yokoyama, Noboru Hattori
Abstract
BACKGROUND:A significant number of children with asthma show remission in adulthood. Although these adults are often diagnosed with chronic obstructive pulmonary disease in later life, the effect of clinically remitted childhood asthma on the decline in lung function during adulthood is uncertain.
OBJECTIVE:We examined whether clinical remission of childhood asthma was associated with an accelerated decline in lung function in apparently non-asthmatic adults.
METHODS:Here, 3584 participants (mean age, 48.1 years; range, 35-65 years) who did not have adulthood asthma and other lung diseases and had normal lung function at the baseline visit were included. They were categorised as follows: those with remitted childhood asthma (n=121) and healthy controls (n=3463) according to their self-reported childhood asthma history. Spirometry was performed at baseline and follow-up visits.
RESULTS:The mean follow-up time was 5.3 years. Multivariate regression analysis showed that remitted childhood asthma and smoking were independently associated with a rapid decline in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Besides, smoking was an independent predictor of a rapid decline in the FEV1/FVC. The annual decline in FEV1 and FVC was significantly greater in participants with remitted childhood asthma than in healthy controls, and the differences remained significant after adjusting for the propensity score.
CONCLUSION:A history of clinically remitted childhood asthma is an independent risk factor for accelerated decline in lung function in adults. Remitted childhood asthma and smoking may additively accelerate the development of obstructive lung disease.
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