父母报告有肺炎病史的哮喘少年儿童是否易发需治疗的呼吸道疾病
2011/10/13
摘要
背景：门诊就诊的哮喘患儿和青少年常常存在肺炎病史。有或无肺炎病史的哮喘患者之间是否存在呼吸道症状、肺功能和气道炎症差异，目前尚存在争议。
目的：本研究旨在比较有或无肺炎病史的门诊哮喘患者间的临床指标、肺功能和炎症指标。
方法：190名年龄6～18岁的门诊哮喘患者入选，评价其呼吸道症状、肺功能（流速、体积和非弥散能力，DLCO/VA）及过敏性气道炎症（通过呼出气一氧化氮分数检测）。前期肺炎的放射学和医学诊断定义为：若患者出现至少3次肺炎，或1年内出现2次肺炎发作，定为肺炎复发。
结果：190名参与者中，38名患者（20%）存在肺炎病史。与无肺炎病史的患者相比（n=152），这些患者在过去4周内较常发生上呼吸道症状和夜间觉醒，有较多患者需要每日皮质激素吸入，FE（NO）较低[FE(NO): 20.6 ppb, 95% CI: 15.2-28.0 vs. 31.1 ppb, 95% CI: 27.0-35.8; p <0.05]。38名有肺炎病史的患者中，14名存在肺炎复发。尽管肺体积和流速上具有相似性，但是肺炎复发患者的DLCO/VA显著低于无肺炎复发的哮喘患儿和无肺炎病史的哮喘患儿 (DLCO/VA%: 91.2 ± 11.3 vs. 108.5 ± 14.7 vs. 97.9 ± 18.6, p <0.05)。
结论：对有肺炎病史特别是肺炎复发病史的哮喘少年儿童进行呼吸系统检查，所获症状常常需要糖皮质激素治疗，尽管肺体积和呼气流速正常，但反应肺弥散和过敏性气道炎症的指标（DLCO/VA 和 FENO）存在轻度下降。这些呼吸道异常是否会持续至成人期尚需进一步研究。
(林江涛 审校)
J Asthma. 2011 Sep;48(7):714-20. Epub 2011 Jul 28.
Does a parent-reported history of pneumonia increase the likelihood of respiratory symptoms needing therapy in asthmatic children and adolescents?
Barreto M, Bonafoni S, Barberi S, La Penna F, Zambardi R, Martella S, Villa MP.
Source
NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, University "La Sapienza" , Rome , Italy.
Abstract
BACKGROUND： Asthmatic children and adolescents attending outpatient clinics often have a history of pneumonia. Whether respiratory symptoms, lung function, and airway inflammation differ in asthmatic patients with and without a history of pneumonia remains controversial.
AIMS：To compare clinical, lung functional, and inflammatory variables in asthmatic outpatients with and without a history of pneumonia.
METHODS： In 190 asthmatic outpatients, aged 6-18 years, we assessed respiratory symptoms, lung function (flows, volumes, and pulmonary diffusion capacity, DLCO/VA), and atopic-airway inflammation as measured by the fractional concentration of exhaled nitric oxide (FE(NO)). A previous medical and radiological diagnosis of pneumonia was defined as "recurrent pneumonia" if subjects had at least three pneumonia episodes or two episodes within a year.
RESULTS： Of the 190 outpatients studied, 38 (20%) had a history of pneumonia. These patients had more frequent upper-respiratory symptoms, nighttime awakenings in the past 4 weeks, daily use of inhaled corticosteroids, and lower FE(NO) than the 152 asthmatic children without previous pneumonia (FE(NO): 20.6 ppb, 95% CI: 15.2-28.0 vs. 31.1 ppb, 95% CI: 27.0-35.8; p < .05). Of the 38 patients with previous pneumonia, 14 had recurrent pneumonia. Despite comparable lung volumes and flows, they also had lower DLCO/VA than asthmatic children with no recurrent pneumonia and asthmatic children without previous pneumonia (DLCO/VA%: 91.2 ± 11.3 vs. 108.5 ± 14.7 vs. 97.9 ± 18.6, p < .05).
CONCLUSION： Respiratory assessment in asthmatic children and adolescents with a history of pneumonia, especially recurrent pneumonia, often discloses symptoms needing corticosteroid therapy, and despite normal lung volumes and flows, mild reductions in the variables reflecting gas diffusion and atopic-airway inflammation (DLCO/VA and FE(NO)). Whether these respiratory abnormalities persist in adulthood remains an open question.
J Asthma. 2011 Sep;48(7):714-20. Epub 2011 Jul 28
背景：门诊就诊的哮喘患儿和青少年常常存在肺炎病史。有或无肺炎病史的哮喘患者之间是否存在呼吸道症状、肺功能和气道炎症差异，目前尚存在争议。
目的：本研究旨在比较有或无肺炎病史的门诊哮喘患者间的临床指标、肺功能和炎症指标。
方法：190名年龄6～18岁的门诊哮喘患者入选，评价其呼吸道症状、肺功能（流速、体积和非弥散能力，DLCO/VA）及过敏性气道炎症（通过呼出气一氧化氮分数检测）。前期肺炎的放射学和医学诊断定义为：若患者出现至少3次肺炎，或1年内出现2次肺炎发作，定为肺炎复发。
结果：190名参与者中，38名患者（20%）存在肺炎病史。与无肺炎病史的患者相比（n=152），这些患者在过去4周内较常发生上呼吸道症状和夜间觉醒，有较多患者需要每日皮质激素吸入，FE（NO）较低[FE(NO): 20.6 ppb, 95% CI: 15.2-28.0 vs. 31.1 ppb, 95% CI: 27.0-35.8; p <0.05]。38名有肺炎病史的患者中，14名存在肺炎复发。尽管肺体积和流速上具有相似性，但是肺炎复发患者的DLCO/VA显著低于无肺炎复发的哮喘患儿和无肺炎病史的哮喘患儿 (DLCO/VA%: 91.2 ± 11.3 vs. 108.5 ± 14.7 vs. 97.9 ± 18.6, p <0.05)。
结论：对有肺炎病史特别是肺炎复发病史的哮喘少年儿童进行呼吸系统检查，所获症状常常需要糖皮质激素治疗，尽管肺体积和呼气流速正常，但反应肺弥散和过敏性气道炎症的指标（DLCO/VA 和 FENO）存在轻度下降。这些呼吸道异常是否会持续至成人期尚需进一步研究。
(林江涛 审校)
J Asthma. 2011 Sep;48(7):714-20. Epub 2011 Jul 28.
Does a parent-reported history of pneumonia increase the likelihood of respiratory symptoms needing therapy in asthmatic children and adolescents?
Barreto M, Bonafoni S, Barberi S, La Penna F, Zambardi R, Martella S, Villa MP.
Source
NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, University "La Sapienza" , Rome , Italy.
Abstract
BACKGROUND： Asthmatic children and adolescents attending outpatient clinics often have a history of pneumonia. Whether respiratory symptoms, lung function, and airway inflammation differ in asthmatic patients with and without a history of pneumonia remains controversial.
AIMS：To compare clinical, lung functional, and inflammatory variables in asthmatic outpatients with and without a history of pneumonia.
METHODS： In 190 asthmatic outpatients, aged 6-18 years, we assessed respiratory symptoms, lung function (flows, volumes, and pulmonary diffusion capacity, DLCO/VA), and atopic-airway inflammation as measured by the fractional concentration of exhaled nitric oxide (FE(NO)). A previous medical and radiological diagnosis of pneumonia was defined as "recurrent pneumonia" if subjects had at least three pneumonia episodes or two episodes within a year.
RESULTS： Of the 190 outpatients studied, 38 (20%) had a history of pneumonia. These patients had more frequent upper-respiratory symptoms, nighttime awakenings in the past 4 weeks, daily use of inhaled corticosteroids, and lower FE(NO) than the 152 asthmatic children without previous pneumonia (FE(NO): 20.6 ppb, 95% CI: 15.2-28.0 vs. 31.1 ppb, 95% CI: 27.0-35.8; p < .05). Of the 38 patients with previous pneumonia, 14 had recurrent pneumonia. Despite comparable lung volumes and flows, they also had lower DLCO/VA than asthmatic children with no recurrent pneumonia and asthmatic children without previous pneumonia (DLCO/VA%: 91.2 ± 11.3 vs. 108.5 ± 14.7 vs. 97.9 ± 18.6, p < .05).
CONCLUSION： Respiratory assessment in asthmatic children and adolescents with a history of pneumonia, especially recurrent pneumonia, often discloses symptoms needing corticosteroid therapy, and despite normal lung volumes and flows, mild reductions in the variables reflecting gas diffusion and atopic-airway inflammation (DLCO/VA and FE(NO)). Whether these respiratory abnormalities persist in adulthood remains an open question.
J Asthma. 2011 Sep;48(7):714-20. Epub 2011 Jul 28
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