成人期哮喘发作的危险因素：一项为期14年的纵向研究
2009/10/15
背景与目的：研究成人期哮喘发作自然史及其危险因素的纵向研究很少。本试验旨在评价能预测成人期新诊断哮喘的人群特征和生活方式的预测因子，并研究在发生哮喘和未发生哮喘的人群中相比，这些预测因子随时间的变化规律。
方法：研究纳入巴瑟尔顿健康研究中的1554名成人，于1981年进行首次评价，1994～1995年再次进行评价。最初所有纳入人群从无医生诊断的哮喘。问卷调查用于评价医生诊断的哮喘、呼吸病史和吸烟状态。同时检测身高、体重，采用肺活量检测肺功能。采用皮肤点刺试验检测特应性。采用Logistic回归分析确定成人期哮喘发作的危险因素及其变化规律。
结果：1981年报告的喘息、鼻炎、慢性咳嗽、吸烟和肺功能下降每一项都能预测1994～1995年对哮喘的诊断。初始皮肤针刺反应和随访期皮肤点刺试验阳性与成人期哮喘发作无关。那些诊断为哮喘的患者更易出现喘息、新发鼻炎、新发习惯性打鼾、体重增加及肺功能过度下降。
结论：成人期哮喘发作的危险因素与儿童哮喘不同。出现上呼吸道症状，包括鼻炎，以及与生活方式相关因素，如吸烟，预示这些人群是哮喘发作的最高危险人群。然而，皮肤点刺试验显示的先前存在或新出现的特应性与成人期哮喘发作无关。
（林江涛 审校）
Jamrozik E, et al. Respirology. 2009 Aug;14(6):814-821.
Risk factors for adult-onset asthma: a 14-year longitudinal study.
Jamrozik E, Knuiman MW, James A, Divitini M, Musk AW.
Busselton Health Study, University of Western Australia, Nedlands, WA, Australia. zeb.jamrozik@gmail.com
BACKGROUND AND OBJECTIVES: Few longitudinal studies have examined the risk factors and natural history of adult-onset asthma. This study assessed the subject characteristics and lifestyle factors that predicted the new diagnosis of asthma in adulthood and how these factors changed over time in those who developed asthma compared with those who do not.
METHODS: The study enrolled 1554 adults from the Busselton Health Study seen in 1981 and again in 1994-1995 who initially reported never having had doctor-diagnosed asthma. Questionnaire measures were used to assess doctor-diagnosed asthma, respiratory history and tobacco smoking. Height, weight and spirometric measures of lung function were measured. Atopy was assessed by skin prick tests. Logistic regression analysis was used to identify risk factors for adult-onset asthma and changes over time.
RESULTS: Reported wheeze, rhinitis, chronic cough, smoking and lower levels of lung function in 1981 each predicted asthma diagnosis by 1994-1995. Neither initial skin-prick reactivity nor newly positive skin-prick tests at follow up were associated with adult-onset asthma. Those diagnosed with asthma were more likely to have new wheeze, new rhinitis, new habitual snoring, weight gain and excess decline in lung function.
CONCLUSIONS: Adult-onset asthma has risk factors that are distinct from those observed in childhood asthma. The presence of upper airway symptoms including rhinitis, as well as lifestyle factors, such as smoking, predicts those at greatest risk. However, neither pre-existing atopy nor new atopy as measured by skin prick tests was associated with adult-onset asthma.
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1994～2004年欧洲5个主要国家哮喘死亡率与长效β2激动剂应用相关性研究
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肥胖、腰围及哮喘患病率趋势－加利福尼亚教师队列研究
