低收入国家儿童期哮喘：看不见的杀手
2012/07/05
摘要
在低收入国家，细菌性肺炎是5岁以下儿童呼吸道疾病和呼吸系统疾病死亡的主要原因，而哮喘在这些国家儿童呼吸系统疾病中的地位尚未得到确认。本试验探寻肺炎和哮喘/喘息/支气管炎的定义和概念，研究5岁以下儿童哮喘是否容易与肺炎相混淆。由于临床肺炎与确诊检测（胸片和微生物检测）结果之间相关性有限，会引起细菌性肺炎过度诊断，从而导致抗生素治疗疗效较差。此外，婴儿期反复发作肺炎常常在后期被诊断为哮喘。近期的研究显示，低收入国家，10～15%的学龄前儿童患有哮喘，而且5岁以下长期咳嗽和呼吸困难的患儿有些尚未得到确诊。新的研究显示，基于儿童疾病综合治疗诊断为肺炎而住院的5岁以下儿童，如果采用重新定义的诊断标准和治疗，有约50%的患者被诊断为哮喘或喘息。因此，有可能未得到诊断的哮喘是导致呼吸道疾病死亡的原因，因为呼吸道合胞病毒（RSV）是儿童期导致呼吸道疾病死亡的重要原因，而5岁以下儿童的哮喘常常因为病毒（包括RSV）感染而发作。此外，急性呼吸道疾病治疗失败也常出现于5岁以下无发热的患儿，这表明这些儿童应该诊断为哮喘/喘息，而非细菌性肺炎。潜在的哮喘可能会导致营养不良和致命性细菌性肺炎。总之，低收入国家学龄前儿童哮喘可能存在严重的诊断不足，有可能被误诊为肺炎，是导致呼吸系统疾病及其死亡的主要原因。
(林江涛 审校)
Prim Care RespirJ.2012May23.pii:pcrj-2011-12-0147-R2.doi:10.4104/pcrj.2012.00038. [Epub ahead of print]
Prim Care RespirJ.2012May23.pii:pcrj-2011-12-0147-R2.doi:10.4104/pcrj.2012.00038. [Epub ahead of print]
Source
Department of General Practice and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
Department of General Practice and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
Abstract
Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.
Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.
Prim Care Respir J. 2012 May 23. pii: pcrj-2011-12-0147-R2. doi: 10.4104/pcrj.2012.00038. [Epub ahead of print]
上一篇：
2001-2010年间美国哮喘发病率、卫生保健使用和死亡率趋势
下一篇：
成人哮喘和慢性支气管炎患者的精神健康：西班牙一项人群为基础的研究
