低体重和肥胖儿童的哮喘严重程度、发作风险和哮喘控制治疗负担
2012/07/06
摘要
目的：儿童体重状态与哮喘特征的关系尚不清楚。目前，有关低体重和肥胖的哮喘儿童中，哮喘发作风险、医生诊断的哮喘严重程度和控制治疗水平了解较少。
方法：对4个儿童哮喘专科诊所中一所诊所的10559名新诊断的哮喘患者，基于3个BMI分层，对诊断的哮喘严重程度、肺功能、哮喘发作发生率和哮喘控制治疗水平进行评价。根据疾病控制和预防分类标准，基于体重指数（BMI）-百分位数对受试者进行分析。采用多变量回归模型评价BMI-百分位数队列组与哮喘转归之间的关系。
结果：相对于肥胖哮喘患者来说，低体重哮喘患者比例较低，但这些患儿的用力肺活量受影响最大，而且具有最大的控制治疗负担。肥胖哮喘儿童占队列人群的26.2%，与正常体重哮喘患者相比，更有可能出现严重哮喘（OR：1.40, 95% CI：1.06-1.85）和气流阻塞（OR 1.36, 95% CI 1.16-1.59）。肥胖的哮喘患者其哮喘发作（OR 1.41, 95% CI 0.64-3.11）和治疗负担（OR 1.03, 95% CI 0.83-1.28）风险并未显著增加。
结论：对于哮喘患者，肥胖相对于低体重更为常见。虽然低体重和肥胖的哮喘儿童在表现型特征上存在差异，但与正常体重儿童相比，两者的肺功能均较差，而且哮喘相关转归也较差。
（林江涛 审校）
J Asthma. 2012 Apr 25. [Epub ahead of print]
Asthma Severity, Exacerbation Risk, and Controller Treatment Burden in Underweight and Obese Children.
Lang JE, Hossain J, Smith K, Lima JJ.
Source
Division of Pulmonology, Allergy & Immunology, Nemours Children’s Clinic , Jacksonville, FL , USA.
Abstract
OBJECTIVE:The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting.
METHODS:We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes.
RESULTS:Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06-1.85) and airflow obstruction (OR 1.36, 95% CI 1.16-1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64-3.11) or high treatment burden (OR 1.03, 95% CI 0.83-1.28).
CONCLUSIONS: Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.
J Asthma. 2012 Apr 25. [Epub ahead of print]
目的：儿童体重状态与哮喘特征的关系尚不清楚。目前，有关低体重和肥胖的哮喘儿童中，哮喘发作风险、医生诊断的哮喘严重程度和控制治疗水平了解较少。
方法：对4个儿童哮喘专科诊所中一所诊所的10559名新诊断的哮喘患者，基于3个BMI分层，对诊断的哮喘严重程度、肺功能、哮喘发作发生率和哮喘控制治疗水平进行评价。根据疾病控制和预防分类标准，基于体重指数（BMI）-百分位数对受试者进行分析。采用多变量回归模型评价BMI-百分位数队列组与哮喘转归之间的关系。
结果：相对于肥胖哮喘患者来说，低体重哮喘患者比例较低，但这些患儿的用力肺活量受影响最大，而且具有最大的控制治疗负担。肥胖哮喘儿童占队列人群的26.2%，与正常体重哮喘患者相比，更有可能出现严重哮喘（OR：1.40, 95% CI：1.06-1.85）和气流阻塞（OR 1.36, 95% CI 1.16-1.59）。肥胖的哮喘患者其哮喘发作（OR 1.41, 95% CI 0.64-3.11）和治疗负担（OR 1.03, 95% CI 0.83-1.28）风险并未显著增加。
结论：对于哮喘患者，肥胖相对于低体重更为常见。虽然低体重和肥胖的哮喘儿童在表现型特征上存在差异，但与正常体重儿童相比，两者的肺功能均较差，而且哮喘相关转归也较差。
（林江涛 审校）
J Asthma. 2012 Apr 25. [Epub ahead of print]
Asthma Severity, Exacerbation Risk, and Controller Treatment Burden in Underweight and Obese Children.
Lang JE, Hossain J, Smith K, Lima JJ.
Source
Division of Pulmonology, Allergy & Immunology, Nemours Children’s Clinic , Jacksonville, FL , USA.
Abstract
OBJECTIVE:The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting.
METHODS:We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes.
RESULTS:Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06-1.85) and airflow obstruction (OR 1.36, 95% CI 1.16-1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64-3.11) or high treatment burden (OR 1.03, 95% CI 0.83-1.28).
CONCLUSIONS: Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.
J Asthma. 2012 Apr 25. [Epub ahead of print]
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初级保健机构COPD和哮喘鉴别诊断的困难
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呼出气一氧化氮分数（FeNO）在哮喘诊断中的作用
