SARS-CoV-2感染对哮喘恶化的长期影响
2025/06/27
摘要
背景：COVID-19对哮喘急性发作的长期影响尚不明确。
目的：我们评估了儿童及成人哮喘患者在SARS-CoV-2感染后远期急性发作的风险。
方法：本研究在大型城市医疗系统（2020年3月1日-2023年12月31日）中纳入12,719例经PCR确诊的SARS-CoV-2感染哮喘患者和91,763例无感染记录的哮喘患者进行回顾性队列研究。经观察时间、年龄、种族和民族匹配后，每组（感染组与未感染组）各纳入1,898名儿童和8,532名成人。采用经协变量（如过敏性鼻炎、胃食管反流病、湿疹、肥胖、未满足社会需求等）校正的Andersen-Gill模型计算哮喘反复急性发作的校正风险比（aHR）。
结果: 既往确诊哮喘的COVID-19感染儿童（无论住院与否）急性发作率均高于对照组（40.68%、24.81% vs 14.70%，p<0.001），且远期发作风险显著增加（aHR=3.29[2.27-4.76]；aHR=1.82[1.51-2.21]，p<0.001）。成人患者中，住院（23.13%）与非住院（21.49%）COVID-19感染者的急性发作率也显著高于对照组（10.68%）（p<0.001），其远期发作风险同样升高（住院aHR=2.78[2.29-3.38]；非住院aHR=2.13[1.73-2.62]）。总体而言，儿童患者风险增幅高于成人。未满足社会需求会进一步增加儿童（aHR=1.36[1.00-1.86]）和成人（aHR=1.26[1.04-1.52]）的远期发作风险。
结论：SARS-CoV-2感染与哮喘急性发作累积发生率升高显著相关，存在社会需求未满足的患者发作风险更高。临床医生应针对有哮喘病史合并SARS-CoV-2感染的患者优先采取预防策略、触发因素控制和免疫接种措施。
背景：COVID-19对哮喘急性发作的长期影响尚不明确。
目的：我们评估了儿童及成人哮喘患者在SARS-CoV-2感染后远期急性发作的风险。
方法：本研究在大型城市医疗系统（2020年3月1日-2023年12月31日）中纳入12,719例经PCR确诊的SARS-CoV-2感染哮喘患者和91,763例无感染记录的哮喘患者进行回顾性队列研究。经观察时间、年龄、种族和民族匹配后，每组（感染组与未感染组）各纳入1,898名儿童和8,532名成人。采用经协变量（如过敏性鼻炎、胃食管反流病、湿疹、肥胖、未满足社会需求等）校正的Andersen-Gill模型计算哮喘反复急性发作的校正风险比（aHR）。
结果: 既往确诊哮喘的COVID-19感染儿童（无论住院与否）急性发作率均高于对照组（40.68%、24.81% vs 14.70%，p<0.001），且远期发作风险显著增加（aHR=3.29[2.27-4.76]；aHR=1.82[1.51-2.21]，p<0.001）。成人患者中，住院（23.13%）与非住院（21.49%）COVID-19感染者的急性发作率也显著高于对照组（10.68%）（p<0.001），其远期发作风险同样升高（住院aHR=2.78[2.29-3.38]；非住院aHR=2.13[1.73-2.62]）。总体而言，儿童患者风险增幅高于成人。未满足社会需求会进一步增加儿童（aHR=1.36[1.00-1.86]）和成人（aHR=1.26[1.04-1.52]）的远期发作风险。
结论：SARS-CoV-2感染与哮喘急性发作累积发生率升高显著相关，存在社会需求未满足的患者发作风险更高。临床医生应针对有哮喘病史合并SARS-CoV-2感染的患者优先采取预防策略、触发因素控制和免疫接种措施。
（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）
（J Allergy Clin Immunol Pract 2025 May 10;0(0)DOI：10.1016/j.jaip.2025.05.010.IF: 7.574）
Longer Term Effects of SARS-CoV-2 infection on Asthma Exacerbation.
Kevin E, Duong; Sonya S, Henry;
Abstrast
Background: The long-term impact of COVID-19 on asthma exacerbations remains unclear. OBJECTIVE: We assessed the future risk of asthma exacerbations after SARS-CoV-2 infection in pediatric and adult asthma patients.
Methods: We conducted a retrospective cohort study of 12,719 asthma patients with SARS-CoV-2 infection (polymerase-chain-reaction test confirmed) and 91,763 without recorded SARS-CoV-2 infection in a large urban health care system (03/1/2020-12/31/2023). After matching on observation time, age, race, and ethnicity, 1898 children and 8532 adults were included in each group (with and without COVID-19). Andersen-Gill models adjusted for covariates (e.g., allergic rhinitis, GERD, eczema, obesity, unmet social needs) were used to calculate adjusted hazard ratios (aHR) for recurrent asthma exacerbations.
Results: Both hospitalized and non-hospitalized COVID-19 children with pre-existing asthma had higher exacerbation rates than controls (40.68%, 24.81%, vs. 14.70%, p<0.001) and increased risk of future exacerbations (aHR=3.29 [2.27, 4.76]; aHR=1.82 [1.51, 2.21]), p<0.001). Adults also showed increased asthma exacerbation rates in hospitalized (23.13%) and non-hospitalized (21.49%) individuals when compared with controls (10.68%), p<0.001. Similarly, both hospitalized and non-hospitalized COVID-19 adults had increased risk of future exacerbations (aHR=2.78 [2.29, 3.38]; aHR=2.13 [1.73, 2.62]). Overall, children faced higher risks than adults. Unmet social needs elevated risk of future exacerbation in children (aHR=1.36 [1.00, 1.86]) and adults (aHR=1.26 [1.04, 1.52]).
Conclusion: SARS-CoV-2 infection was associated with a higher cumulative incidence of asthma exacerbations. Patients with unmet social needs were at higher risk of exacerbation. Clinicians should prioritize preventive strategies, trigger reduction, and immunizations for patients with a history of asthma and SARS-CoV-2 infection.
Kevin E, Duong; Sonya S, Henry;
Abstrast
Background: The long-term impact of COVID-19 on asthma exacerbations remains unclear. OBJECTIVE: We assessed the future risk of asthma exacerbations after SARS-CoV-2 infection in pediatric and adult asthma patients.
Methods: We conducted a retrospective cohort study of 12,719 asthma patients with SARS-CoV-2 infection (polymerase-chain-reaction test confirmed) and 91,763 without recorded SARS-CoV-2 infection in a large urban health care system (03/1/2020-12/31/2023). After matching on observation time, age, race, and ethnicity, 1898 children and 8532 adults were included in each group (with and without COVID-19). Andersen-Gill models adjusted for covariates (e.g., allergic rhinitis, GERD, eczema, obesity, unmet social needs) were used to calculate adjusted hazard ratios (aHR) for recurrent asthma exacerbations.
Results: Both hospitalized and non-hospitalized COVID-19 children with pre-existing asthma had higher exacerbation rates than controls (40.68%, 24.81%, vs. 14.70%, p<0.001) and increased risk of future exacerbations (aHR=3.29 [2.27, 4.76]; aHR=1.82 [1.51, 2.21]), p<0.001). Adults also showed increased asthma exacerbation rates in hospitalized (23.13%) and non-hospitalized (21.49%) individuals when compared with controls (10.68%), p<0.001. Similarly, both hospitalized and non-hospitalized COVID-19 adults had increased risk of future exacerbations (aHR=2.78 [2.29, 3.38]; aHR=2.13 [1.73, 2.62]). Overall, children faced higher risks than adults. Unmet social needs elevated risk of future exacerbation in children (aHR=1.36 [1.00, 1.86]) and adults (aHR=1.26 [1.04, 1.52]).
Conclusion: SARS-CoV-2 infection was associated with a higher cumulative incidence of asthma exacerbations. Patients with unmet social needs were at higher risk of exacerbation. Clinicians should prioritize preventive strategies, trigger reduction, and immunizations for patients with a history of asthma and SARS-CoV-2 infection.
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