年龄对儿童哮喘临床特征、药物管理和病情加重的影响
2023/12/20
摘要
背景：哮喘试验和指南通常不区分青少年和年幼儿童。我们利用大量的英国数据集评估了年龄对哮喘特征，管理和恶化的影响。
方法：2004-2021 年初级保健医疗记录与医院记录相关联。儿童按诊断时的年龄分类，并随访至下一个年龄段。年龄（基于管理指南）分别为 5-8 岁、9-11 岁和青少年（12-16 岁）。评估的特征包括体重指数、过敏和诊断前后的事件（症状、药物）。计算急性加重发生率。用多变量 Cox 比例风险决定其与急性加重的关联。
结果：119611名儿童符合条件：61名 940（51.8%）5-8岁，32 316（27.7%）9-11岁和25岁 355名（21.2%）青少年。几个特征因年龄而异：5-8岁儿童发生湿疹、食物/药物过敏和咳嗽的比例最高；青少年发生超重/肥胖、气致过敏原致敏、呼吸困难和仅使用短效-受体激动剂的比例最高。最年幼儿童的恶化率最高(每100人年(95%CI): 5-8岁=13.7(13.4-13.9)，9-11岁=10.0(9.8-10.4)，青少年=6.7(6.5-7.0))。加重风险因素也因年龄而异：5-8岁:男性，湿疹和食物/药物过敏密切相关，但对于≥9岁的儿童，肥胖和气致过敏原过敏密切相关。对所有儿童而言，较高的社会经济剥夺与病情恶化显著相关。延迟诊断在5-8岁儿童中最常见，并且与所有年龄段的加重有关。
结论：儿童的基线特征和恶化率因年龄组而异。临床指南应更谨慎地考虑诊断时的年龄，而不是广泛的为5-16岁，因为这似乎对哮喘的严重程度和管理有影响。
Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma.
Khalaf Z, Bush A, Saglani S, Bloom CI,
Abstrast
Background: Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations.
Methods: Primary care medical records, 2004-2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5-8 years, 9-11 years and adolescents (12-16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations.
Results: 119 611 children were eligible: 61 940 (51.8%) 5-8 years, 32 316 (27.7%) 9-11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5-8 years had the highest proportion with eczema, food/drug allergy and cough, but adolescents had the highest proportion with overweight/obesity, aeroallergen sensitisation, dyspnoea and short-acting-beta-agonist only use. Exacerbation rates were highest in the youngest children (per 100 person-years (95% CI): 5-8 years =13.7 (13.4-13.9), 9-11 years =10.0 (9.8-10.4), adolescents =6.7 (6.5-7.0)). Exacerbation risk factors also differed by age; 5-8 years: male, eczema and food/drug allergy were strongly associated, but for children ≥9 years old, obesity and aeroallergen sensitisation were strongly associated. For all children, higher socioeconomic deprivation was significantly associated with having an exacerbation. Delayed diagnosis was most common in children aged 5-8 years and was associated with increased exacerbations across all ages.
Conclusions: Children's baseline characteristics and exacerbation rates varied according to their age group. Clinical guidelines should consider age at time of diagnosis more discretely than the broad range, 5-16 years, as this appears to impact on asthma severity and management.
背景：哮喘试验和指南通常不区分青少年和年幼儿童。我们利用大量的英国数据集评估了年龄对哮喘特征，管理和恶化的影响。
方法：2004-2021 年初级保健医疗记录与医院记录相关联。儿童按诊断时的年龄分类，并随访至下一个年龄段。年龄（基于管理指南）分别为 5-8 岁、9-11 岁和青少年（12-16 岁）。评估的特征包括体重指数、过敏和诊断前后的事件（症状、药物）。计算急性加重发生率。用多变量 Cox 比例风险决定其与急性加重的关联。
结果：119611名儿童符合条件：61名 940（51.8%）5-8岁，32 316（27.7%）9-11岁和25岁 355名（21.2%）青少年。几个特征因年龄而异：5-8岁儿童发生湿疹、食物/药物过敏和咳嗽的比例最高；青少年发生超重/肥胖、气致过敏原致敏、呼吸困难和仅使用短效-受体激动剂的比例最高。最年幼儿童的恶化率最高(每100人年(95%CI): 5-8岁=13.7(13.4-13.9)，9-11岁=10.0(9.8-10.4)，青少年=6.7(6.5-7.0))。加重风险因素也因年龄而异：5-8岁:男性，湿疹和食物/药物过敏密切相关，但对于≥9岁的儿童，肥胖和气致过敏原过敏密切相关。对所有儿童而言，较高的社会经济剥夺与病情恶化显著相关。延迟诊断在5-8岁儿童中最常见，并且与所有年龄段的加重有关。
结论：儿童的基线特征和恶化率因年龄组而异。临床指南应更谨慎地考虑诊断时的年龄，而不是广泛的为5-16岁，因为这似乎对哮喘的严重程度和管理有影响。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(Thorax 2023 Dec 07;doi: 10.1136/thorax-2023-220603. IF: 8.834)
(Thorax 2023 Dec 07;doi: 10.1136/thorax-2023-220603. IF: 8.834)
Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma.
Khalaf Z, Bush A, Saglani S, Bloom CI,
Abstrast
Background: Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations.
Methods: Primary care medical records, 2004-2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5-8 years, 9-11 years and adolescents (12-16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations.
Results: 119 611 children were eligible: 61 940 (51.8%) 5-8 years, 32 316 (27.7%) 9-11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5-8 years had the highest proportion with eczema, food/drug allergy and cough, but adolescents had the highest proportion with overweight/obesity, aeroallergen sensitisation, dyspnoea and short-acting-beta-agonist only use. Exacerbation rates were highest in the youngest children (per 100 person-years (95% CI): 5-8 years =13.7 (13.4-13.9), 9-11 years =10.0 (9.8-10.4), adolescents =6.7 (6.5-7.0)). Exacerbation risk factors also differed by age; 5-8 years: male, eczema and food/drug allergy were strongly associated, but for children ≥9 years old, obesity and aeroallergen sensitisation were strongly associated. For all children, higher socioeconomic deprivation was significantly associated with having an exacerbation. Delayed diagnosis was most common in children aged 5-8 years and was associated with increased exacerbations across all ages.
Conclusions: Children's baseline characteristics and exacerbation rates varied according to their age group. Clinical guidelines should consider age at time of diagnosis more discretely than the broad range, 5-16 years, as this appears to impact on asthma severity and management.
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性别对重症哮喘的影响：英国初级和专科护理的横断面回顾性分析
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重症哮喘患者T2相关合并症与生物制剂疗效的关系
