哮喘联盟

    年轻人哮喘的发病率不断增加。本研究力图评价性别及早期因素对年轻人早期诊断哮喘的影响。在Tucson 儿童呼吸研究中共纳入1246名健康新生儿。在6岁前记录其父母特点、早期喘息表现，气道功能、对干冷空气的气道高反应性及对烟草赤星病菌的敏感性。在22岁时记录有无医师诊断的慢性或新发哮喘，并测定气道功能。
    结果发现入选的1246名婴儿中849名有22岁时的随访数据。16～22岁哮喘的平均年发病率为12.6/千人。22岁时诊断的181名哮喘患者中有40人（27%）为初次诊断，其中35人（71%）是女性。男性22年中哮喘的复发率高于女性（多项式比值比[M-OR] 2.0, 95% CI 1.2-3.2, p=0.008).诊断年龄与22岁时的FEV1/FVC 成线性相关。与22年中慢性哮喘相关的因素包括6岁内发病(7.4, 3.9-14.0)、早期持续喘鸣 (14.0, 6.8-28.0)、对烟草赤星病菌敏感(3.6, 2.1-6.4),6岁时气道功能下降(2.1, 1.1-3.9),及6岁时气道反应性增高(4.5, 1.9-10.0)。6岁时气道反应性增高(6.9, 2.3-21.0)，气道功能下降(2.8, 1.1-6.9),迟发(4.6, 1.7-12.0) 及持续喘鸣 (4.0, 1.2-14.0)则可预测22岁时初次诊断的哮喘。 因此年轻人罹患哮喘与幼年有关。

（马艳良 北京大学人民医院呼吸科 100044 摘译）
（Lancet. 2008 Sep 20;372(9643):1058-1064）

Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study.

Stern DA, Morgan WJ, Halonen M, Wright AL, Martinez FD.
Lancet. 2008 Sep 20;372(9643):1058-64.

BACKGROUND: Incidence of asthma increases during early adulthood. We aimed to estimate the contributions of sex and early life factors to asthma diagnosed in young adults. 
METHODS: 1246 healthy newborn babies were enrolled in the Tucson Children’s Respiratory Study. Parental characteristics, early-life wheezing phenotypes, airway function, and bronchial hyper-responsiveness to cold dry air and sensitisation to Alternaria alternata were determined before age 6 years. Physician-diagnosed asthma, both chronic and newly diagnosed, and airway function were recorded at age 22 years.
FINDINGS: Of 1246 babies enrolled, 849 had follow-up data at 22 years. Average incidence of asthma at age 16-22 years was 12.6 per thousand person-years. 49 (27%) of all 181 cases of active asthma at 22 years were newly diagnosed, of which 35 (71%) were women. Asthma remittance by 22 years was higher in men than in women (multinomial odds ratio [M-OR] 2.0, 95% CI 1.2-3.2, p=0.008). Age at diagnosis was linearly associated with the ratio of forced expiratory volume at 1 s to forced vital capacity at age 22 years. Factors independently associated with chronic asthma at 22 years included onset at 6 years (7.4, 3.9-14.0) and persistent wheezing (14.0, 6.8-28.0) in early life, sensitisation to A alternata (3.6, 2.1-6.4), low airway function at age 6 years (2.1, 1.1-3.9), and bronchial hyper-responsiveness at 6 years (4.5, 1.9-10.0). Bronchial hyper-responsiveness (6.9, 2.3-21.0), low airway function at 6 years (2.8, 1.1-6.9), and late-onset (4.6, 1.7-12.0) and persistent wheezing (4.0, 1.2-14.0) predicted newly diagnosed asthma at age 22 years. 
INTERPRETATION: Asthma with onset in early adulthood has its origins in early childhood.