摘要
背景：早期哮喘控制对儿童长期结局的潜在影响尚不清楚。
目的：研究学龄前儿童诊断后2年内的哮喘控制轨迹是否与长期哮喘控制不佳相关。
方法：我们进行了一项基于人群的多中心回顾性队列研究，包括来自行政数据库的4个加拿大省级出生队列。我们纳入了被诊断为哮喘的学龄前儿童(小于5岁)，定义为在两年内因哮喘住院一次或就诊两次。采用经过验证的指数在诊断后四个6个月期间确定的哮喘控制轨迹分为：全程控制、改善控制、波动控制、恶化控制和全程失控。哮喘长期控制不佳被定义为每周≥4次短效β-2激动剂平均剂量或急性加重，在指数年龄6岁、8岁、10岁、12岁、14岁和16岁之前的6个月内测量。采用鲁棒泊松模型估算所有指标年龄中长期控制不佳的平均风险比（RRs），并使用随机效应模型进行荟萃分析。
结果：在50188名患有哮喘的学龄前儿童中，所有指标年龄段哮喘长期控制不佳的合并平均风险为42%(95%CI 34.6%,49.4%)。与全程控制的儿童相比，长期控制不佳的儿童在每个轨迹上的RRs(95%CI)逐渐升高：改善控制，1.38(1.28，1.49)；波动控制，1.54(1.40，1.68)；恶化控制，1.70(1.55，1.86)；全程失控，2.00(1.80，2.21)。
结论：在学龄前诊断后不久，哮喘控制轨迹的次优与长期哮喘控制不佳有关。早期控制轨迹有望预测长期不良结局的风险。
Association between asthma control trajectories in preschoolers and long-term asthma control
Cristina Longo, Lucie Blais, Marni Brownell, Jacqueline Mary Quail, Mohsen Sadatsafavi, Amélie Forget, Marc-André Turcot, Wenbin Li, Nirmal Sidhu, Hamid Tavakoli, Qier Tan, Robert William Platt, Francine Monique Ducharme
Abstract
BACKGROUND: The potential influence of asthma control in early life on long-term outcomes in childhood remains largely unknown.
OBJECTIVE: To examine whether asthma control trajectories in the 2 years post-diagnosis in preschoolers are associated with long-term unsatisfactory asthma control.
METHODS:We conducted a multicenter population-based retrospective cohort study, including 4 Canadian provincial birth cohorts derived from administrative databases. We included preschoolers (<5 years) diagnosed with asthma, defined as having one hospitalization or two physician visits for asthma within two years. Asthma control trajectories, ascertained over four 6-month periods post-diagnosis using a validated index, were classified into: controlled throughout, improving control, fluctuating control, worsening control, and out-of-control throughout. Long-term unsatisfactory control was defined as ≥4 short-acting beta-2 agonist average doses per week or an exacerbation, measured within 6 months before index ages 6, 8, 10, 12, 14, and 16 years. Average risk ratios (RRs) for long-term unsatisfactory control across all index ages were estimated using a robust Poisson model by province and meta-analyzed with a random effects model.
RESULTS: In 50,188 preschoolers with asthma, the pooled average risk of having unsatisfactory control at any index age was 42% (95%CI 34.6%,49.4%). Compared to children controlled throughout, incrementally higher average RRs (95%CI) of long-term unsatisfactory control were observed in each trajectory: improving control, 1.38 (1.28,1.49); fluctuating control, 1.54 (1.40,1.68); worsening control, 1.70 (1.55,1.86); out-of-control throughout, 2.00 (1.80,2.21).
CONCLUSIONS: Suboptimal asthma control trajectories shortly following a preschool diagnosis were associated with long-term unsatisfactory asthma control. Early control trajectories appear promising for predicting the risk of long-term adverse outcomes.
背景：早期哮喘控制对儿童长期结局的潜在影响尚不清楚。
目的：研究学龄前儿童诊断后2年内的哮喘控制轨迹是否与长期哮喘控制不佳相关。
方法：我们进行了一项基于人群的多中心回顾性队列研究，包括来自行政数据库的4个加拿大省级出生队列。我们纳入了被诊断为哮喘的学龄前儿童(小于5岁)，定义为在两年内因哮喘住院一次或就诊两次。采用经过验证的指数在诊断后四个6个月期间确定的哮喘控制轨迹分为：全程控制、改善控制、波动控制、恶化控制和全程失控。哮喘长期控制不佳被定义为每周≥4次短效β-2激动剂平均剂量或急性加重，在指数年龄6岁、8岁、10岁、12岁、14岁和16岁之前的6个月内测量。采用鲁棒泊松模型估算所有指标年龄中长期控制不佳的平均风险比（RRs），并使用随机效应模型进行荟萃分析。
结果：在50188名患有哮喘的学龄前儿童中，所有指标年龄段哮喘长期控制不佳的合并平均风险为42%(95%CI 34.6%,49.4%)。与全程控制的儿童相比，长期控制不佳的儿童在每个轨迹上的RRs(95%CI)逐渐升高：改善控制，1.38(1.28，1.49)；波动控制，1.54(1.40，1.68)；恶化控制，1.70(1.55，1.86)；全程失控，2.00(1.80，2.21)。
结论：在学龄前诊断后不久，哮喘控制轨迹的次优与长期哮喘控制不佳有关。早期控制轨迹有望预测长期不良结局的风险。
(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)
(J Allergy Clin Immunol Pract. 2022 Jan 17;S2213-2198(22)00008-3. doi: 10.1016/j.jaip.2021.12.033.)
(J Allergy Clin Immunol Pract. 2022 Jan 17;S2213-2198(22)00008-3. doi: 10.1016/j.jaip.2021.12.033.)
Association between asthma control trajectories in preschoolers and long-term asthma control
Cristina Longo, Lucie Blais, Marni Brownell, Jacqueline Mary Quail, Mohsen Sadatsafavi, Amélie Forget, Marc-André Turcot, Wenbin Li, Nirmal Sidhu, Hamid Tavakoli, Qier Tan, Robert William Platt, Francine Monique Ducharme
Abstract
BACKGROUND: The potential influence of asthma control in early life on long-term outcomes in childhood remains largely unknown.
OBJECTIVE: To examine whether asthma control trajectories in the 2 years post-diagnosis in preschoolers are associated with long-term unsatisfactory asthma control.
METHODS:We conducted a multicenter population-based retrospective cohort study, including 4 Canadian provincial birth cohorts derived from administrative databases. We included preschoolers (<5 years) diagnosed with asthma, defined as having one hospitalization or two physician visits for asthma within two years. Asthma control trajectories, ascertained over four 6-month periods post-diagnosis using a validated index, were classified into: controlled throughout, improving control, fluctuating control, worsening control, and out-of-control throughout. Long-term unsatisfactory control was defined as ≥4 short-acting beta-2 agonist average doses per week or an exacerbation, measured within 6 months before index ages 6, 8, 10, 12, 14, and 16 years. Average risk ratios (RRs) for long-term unsatisfactory control across all index ages were estimated using a robust Poisson model by province and meta-analyzed with a random effects model.
RESULTS: In 50,188 preschoolers with asthma, the pooled average risk of having unsatisfactory control at any index age was 42% (95%CI 34.6%,49.4%). Compared to children controlled throughout, incrementally higher average RRs (95%CI) of long-term unsatisfactory control were observed in each trajectory: improving control, 1.38 (1.28,1.49); fluctuating control, 1.54 (1.40,1.68); worsening control, 1.70 (1.55,1.86); out-of-control throughout, 2.00 (1.80,2.21).
CONCLUSIONS: Suboptimal asthma control trajectories shortly following a preschool diagnosis were associated with long-term unsatisfactory asthma control. Early control trajectories appear promising for predicting the risk of long-term adverse outcomes.
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