通过哮喘严重程度进行儿童哮喘临床分型
2010/11/04
摘要
在对儿童哮喘严重程度和哮喘控制进行评价时，常常受到哮喘临床表现存在差异的困扰。对于儿童哮喘症状与客观检测结果之间，尚未建立确切的联系。本研究对115名学龄期哮喘患儿进行研究，其中31名患儿即使采用大剂量皮质激素吸入（HD-ICS）及至少一种哮喘控制药物治疗，哮喘仍未得到很好控制，这31名患儿定为问题性严重哮喘患者。对于未控制哮喘患者，不管其严重程度何如（恶化及慢性持续性哮喘），对两个存在部分重叠的临床转归进行定义。不管其当前使用何种药物，同样的症状标准也用于问题性严重哮喘。比较有哮喘症状组患儿与哮喘控制较好患儿的肺功能、呼出气一氧化氮（FENO）、支气管反应性、过敏状态及生活质量。多因素分析评价哮喘临床表现的解释程度及HD-ICS治疗的客观检测指标之间的关系。哮喘恶化组患儿与哮喘控制组患儿具有类似的客观特征。慢性持续哮喘组肺功能显著下降、IgE增加、对多种物质过敏、生活质量下降，其表现与问题性严重哮喘患者相似。多因素分析显示，存在慢性哮喘症状，是肺功能下降、生活质量下降及FENO增加的一个重要解释因素。主观检测指标存在差异，表明慢性持续性哮喘患儿与哮喘恶化患儿存在着不同的儿童哮喘表型，而且有不同的临床预后。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 Sep;21(6):945-953.
Asthma severity in childhood, untangling clinical phenotypes*.
Lang A, Mowinckel P, Sachs-Olsen C, Riiser A, Lunde J, Carlsen KH, Lødrup Carlsen KC.
Department of Pediatrics, Oslo University Hospital, Oslo, Norway.
Abstract
Assessment of childhood asthma severity and asthma control encompasses heterogeneous clinical presentations. The relationship between patterns of asthma symptoms and objective measurements is poorly defined in pediatric asthma. This study includes 115 asthmatic schoolchildren, of which 31 were at inclusion defined as Problematic severe asthma because of inadequate asthma control in the presence of high-dose inhaled corticosteroid (HD-ICS) treatment and at least one other asthma controller drug. Two partially overlapping clinical outcomes were defined irrespective of severity classification (Exacerbations and Chronic persistent asthma) in patients with uncontrolled asthma. The same symptom criteria were used as for Problematic severe asthma, but disregarding current medication. Lung function, exhaled nitric oxide (FE(NO)), bronchial hyperresponsiveness, allergic sensitization and Quality of life (QoL) in the symptom subgroups were compared to children with well-controlled asthma. Multifactor analysis was performed to assess the relative explanatory power of clinical asthma presentations and of HD-ICS treatment on objective measurements. Whereas children included in the Exacerbations subgroup had objective features similar to patients with well-controlled asthma, the Chronic persistent asthma subgroup demonstrated significantly reduced lung function, increased immunoglobin E, allergic poly-sensitization and impaired QoL, similar to that in patients pre-defined as Problematic severe asthma. The presence of chronic asthma symptoms was a significant explanatory factor for reduced lung function, QoL and increased FE(NO) in multifactor analysis. Differences in objective measurements suggest that children with Chronic persistent asthma and those who are symptomatic predominantly during exacerbations may represent distinct phenotypes of childhood asthma with different clinical prognoses.
Pediatr Allergy Immunol. 2010 Sep;21(6):945-53.
在对儿童哮喘严重程度和哮喘控制进行评价时，常常受到哮喘临床表现存在差异的困扰。对于儿童哮喘症状与客观检测结果之间，尚未建立确切的联系。本研究对115名学龄期哮喘患儿进行研究，其中31名患儿即使采用大剂量皮质激素吸入（HD-ICS）及至少一种哮喘控制药物治疗，哮喘仍未得到很好控制，这31名患儿定为问题性严重哮喘患者。对于未控制哮喘患者，不管其严重程度何如（恶化及慢性持续性哮喘），对两个存在部分重叠的临床转归进行定义。不管其当前使用何种药物，同样的症状标准也用于问题性严重哮喘。比较有哮喘症状组患儿与哮喘控制较好患儿的肺功能、呼出气一氧化氮（FENO）、支气管反应性、过敏状态及生活质量。多因素分析评价哮喘临床表现的解释程度及HD-ICS治疗的客观检测指标之间的关系。哮喘恶化组患儿与哮喘控制组患儿具有类似的客观特征。慢性持续哮喘组肺功能显著下降、IgE增加、对多种物质过敏、生活质量下降，其表现与问题性严重哮喘患者相似。多因素分析显示，存在慢性哮喘症状，是肺功能下降、生活质量下降及FENO增加的一个重要解释因素。主观检测指标存在差异，表明慢性持续性哮喘患儿与哮喘恶化患儿存在着不同的儿童哮喘表型，而且有不同的临床预后。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 Sep;21(6):945-953.
Asthma severity in childhood, untangling clinical phenotypes*.
Lang A, Mowinckel P, Sachs-Olsen C, Riiser A, Lunde J, Carlsen KH, Lødrup Carlsen KC.
Department of Pediatrics, Oslo University Hospital, Oslo, Norway.
Abstract
Assessment of childhood asthma severity and asthma control encompasses heterogeneous clinical presentations. The relationship between patterns of asthma symptoms and objective measurements is poorly defined in pediatric asthma. This study includes 115 asthmatic schoolchildren, of which 31 were at inclusion defined as Problematic severe asthma because of inadequate asthma control in the presence of high-dose inhaled corticosteroid (HD-ICS) treatment and at least one other asthma controller drug. Two partially overlapping clinical outcomes were defined irrespective of severity classification (Exacerbations and Chronic persistent asthma) in patients with uncontrolled asthma. The same symptom criteria were used as for Problematic severe asthma, but disregarding current medication. Lung function, exhaled nitric oxide (FE(NO)), bronchial hyperresponsiveness, allergic sensitization and Quality of life (QoL) in the symptom subgroups were compared to children with well-controlled asthma. Multifactor analysis was performed to assess the relative explanatory power of clinical asthma presentations and of HD-ICS treatment on objective measurements. Whereas children included in the Exacerbations subgroup had objective features similar to patients with well-controlled asthma, the Chronic persistent asthma subgroup demonstrated significantly reduced lung function, increased immunoglobin E, allergic poly-sensitization and impaired QoL, similar to that in patients pre-defined as Problematic severe asthma. The presence of chronic asthma symptoms was a significant explanatory factor for reduced lung function, QoL and increased FE(NO) in multifactor analysis. Differences in objective measurements suggest that children with Chronic persistent asthma and those who are symptomatic predominantly during exacerbations may represent distinct phenotypes of childhood asthma with different clinical prognoses.
Pediatr Allergy Immunol. 2010 Sep;21(6):945-53.
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3个版本哮喘控制问卷调查中有关哮喘控制的临界值
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急诊收治的急性哮喘患者的慢性哮喘严重程度的多中心研究
