儿童和青少年气道阻塞伴FEV1正常或低下的临床意义
2024/04/24
摘要
背景：肺活量测定法将气道阻塞定义为1秒用力呼气量（FEV1）与用力肺活量（FVC）之比较低。这种受损的比率可能源于低FEV1（典型）或正常FEV1与大FVC（异常）的组合。儿童和青少年时期异常气道阻塞对普通人群的临床影响尚不清楚。
目的：调查儿童和青少年气道阻塞与FEV1低或正常、哮喘、喘息和支气管高反应性（BHR）之间的关系。
方法：在BAMSE（瑞典巴恩/儿童、过敏、环境、斯德哥尔摩、流行病学）和PIAMA（荷兰哮喘和螨过敏预防和发病率）出生队列中，8、12（仅PIAMA）或16岁时的阻塞（FEV1：FVC比值低于正常下限LLN）被分为典型（FEV1<LLN）或非典型（FEV1≥LLN）阻塞。通过队列调整的逻辑回归对合并数据估计这两种类型的阻塞与呼吸健康结果之间的横断面和纵向关联。
结果：两个队列中8、12和16岁时典型阻塞的患病率分别为1.5%、1.1%和1.5%。非典型阻塞略高：分别为3.9%、2.5%和4.6%。与肺功能正常组相比，无论FEV1如何，阻塞始终与哮喘（非典型阻塞：OR 2.29，95% CI 1.40至3.74）、喘息、哮喘药物使用和BHR的风险较高有关。大约三分之一的儿童期非典型阻塞患者在青春期仍存在非典型阻塞。
临床意义：气道阻塞的儿童和青少年，无论其FEV1水平如何，哮喘和喘息的患病率都较高。在这些年龄段的随访和治疗应由气道阻塞的存在来指导。
Clinical implications of airway obstruction with normal or low FEV1 in childhood and adolescence
Hans Jacob Lohne Koefoed, Gang Wang, Ulrike Gehring, Sandra Ekstrom, Inger Kull, Roel Vermeulen, Jolanda M A Boer, Anna Bergstrom, Gerard H Koppelman, Erik Melén, Judith M Vonk, Jenny Hallberg
Abstract
Background: Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV1 (classic) or a normal FEV1 in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear.
Aims: To investigate the association between airway obstruction with a low or normal FEV1 in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR).
Methods: In the BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV1:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV1 <LLN) or dysanaptic (FEV1 ≥LLN) obstruction. Cross-sectional and longitudinal associations between these two types of obstruction and respiratory health outcomes were estimated by cohort-adjusted logistic regression on pooled data.
Results: The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV1, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95% CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence.
Clinical implications: Children and adolescents with airway obstruction had, regardless of their FEV1 level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.
背景：肺活量测定法将气道阻塞定义为1秒用力呼气量（FEV1）与用力肺活量（FVC）之比较低。这种受损的比率可能源于低FEV1（典型）或正常FEV1与大FVC（异常）的组合。儿童和青少年时期异常气道阻塞对普通人群的临床影响尚不清楚。
目的：调查儿童和青少年气道阻塞与FEV1低或正常、哮喘、喘息和支气管高反应性（BHR）之间的关系。
方法：在BAMSE（瑞典巴恩/儿童、过敏、环境、斯德哥尔摩、流行病学）和PIAMA（荷兰哮喘和螨过敏预防和发病率）出生队列中，8、12（仅PIAMA）或16岁时的阻塞（FEV1：FVC比值低于正常下限LLN）被分为典型（FEV1<LLN）或非典型（FEV1≥LLN）阻塞。通过队列调整的逻辑回归对合并数据估计这两种类型的阻塞与呼吸健康结果之间的横断面和纵向关联。
结果：两个队列中8、12和16岁时典型阻塞的患病率分别为1.5%、1.1%和1.5%。非典型阻塞略高：分别为3.9%、2.5%和4.6%。与肺功能正常组相比，无论FEV1如何，阻塞始终与哮喘（非典型阻塞：OR 2.29，95% CI 1.40至3.74）、喘息、哮喘药物使用和BHR的风险较高有关。大约三分之一的儿童期非典型阻塞患者在青春期仍存在非典型阻塞。
临床意义：气道阻塞的儿童和青少年，无论其FEV1水平如何，哮喘和喘息的患病率都较高。在这些年龄段的随访和治疗应由气道阻塞的存在来指导。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Thorax. 2024 Mar 21:thorax-2023-220952. doi: 10.1136/thorax-2023-220952.)
(Thorax. 2024 Mar 21:thorax-2023-220952. doi: 10.1136/thorax-2023-220952.)
Clinical implications of airway obstruction with normal or low FEV1 in childhood and adolescence
Hans Jacob Lohne Koefoed, Gang Wang, Ulrike Gehring, Sandra Ekstrom, Inger Kull, Roel Vermeulen, Jolanda M A Boer, Anna Bergstrom, Gerard H Koppelman, Erik Melén, Judith M Vonk, Jenny Hallberg
Abstract
Background: Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV1 (classic) or a normal FEV1 in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear.
Aims: To investigate the association between airway obstruction with a low or normal FEV1 in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR).
Methods: In the BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV1:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV1 <LLN) or dysanaptic (FEV1 ≥LLN) obstruction. Cross-sectional and longitudinal associations between these two types of obstruction and respiratory health outcomes were estimated by cohort-adjusted logistic regression on pooled data.
Results: The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV1, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95% CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence.
Clinical implications: Children and adolescents with airway obstruction had, regardless of their FEV1 level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.
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