哮喘联盟

摘要
   目的：运动诱发的喘息（EIW）是哮喘患者的特殊类型，有助于更好地了解哮喘病因。纽约市儿童哮喘患病率和相关的急诊就医在不同的区域间存在差异，在低收入人群中最高。虽然哮喘严重程度增加导致急诊就医差异，当对健康保险进行校正后，我们前期的研究显示，居住在低（3%-9%）和高（11%-19%）哮喘患病率地区的哮喘儿童，其严重程度上不存在差异。对于哮喘患者，我们认为EIW与急诊就医及儿童邻里地区哮喘患病率相关。
   方法：通过基于雇主的医疗保险提供者，有7～8岁儿童的家庭入选一项有关哮喘的病例对照研究。估计哮喘患者（n=195）的EIW患病率（PR）。存在有效肺功能检测、血清特应性及腰围检测指标的140名儿童入选最终模型。
   结果：EIW与因哮喘急医就诊相关(PR, 2.29; P = 0.021)，与频繁的喘息症状无关。与频繁喘息相反，EIW与血清特应性和呼出气一氧化氮（NO）水平无关，表明存在不同的机制。在对种族、母亲哮喘、环境烟草烟雾暴露、家庭收入和邻里收入进行校正后，随着邻里哮喘患病率的增加，哮喘患者EIW患病率也增加。
   结论：EIW可能导致高和低收入邻里地区的哮喘急医就诊出现差异。参与哮喘治疗的医生应该将EIW看作急诊就医的一个风险指标。

                                                                                           （苏楠 审校）
                                                          Pediatrics. 2012 Dec 17. [Epub ahead of print]
 

Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence.

Mainardi TR, Mellins RB, Miller RL, Acosta LM, Cornell A, Hoepner L, Quinn JW, Yan B, Chillrud SN, Olmedo OE, Perera FP, Goldstein IF, Rundle AG, Jacobson JS, Perzanowski MS.

Source
Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, and.

Abstract
OBJECTIVE:Exercise-induced wheeze (EIW) may identify a distinct population among asthmatics and give insight into asthma morbidity etiology. The prevalence of pediatric asthma and associated urgent medical visits varies greatly by neighborhood in New York City and is highest in low-income neighborhoods. Although increased asthma severity might contribute to the disparities in urgent medical visits, when controlling for health insurance coverage, we previously observed no differences in clinical measures of severity between asthmatic children living in neighborhoods with lower (3%-9%) versus higher (11%-19%) asthma prevalence. Among these asthmatics, we hypothesized that EIW would be associated with urgent medical visits and a child's neighborhood asthma prevalence.
METHODS:Families of 7- to 8-year-old children were recruited into a case-control study of asthma through an employer-based health insurance provider. Among the asthmatics (n = 195), prevalence ratios (PRs) for EIW were estimated. Final models included children with valid measures of lung function, seroatopy, and waist circumference (n = 140).
RESULTS:EIW was associated with urgent medical visits for asthma (PR, 2.29; P = .021), independent of frequent wheeze symptoms. In contrast to frequent wheeze, EIW was not associated with seroatopy or exhaled NO, suggesting a distinct mechanism. EIW prevalence among asthmatics increased with increasing neighborhood asthma prevalence (PR, 1.09; P = .012), after adjustment for race, ethnicity, maternal asthma, environmental tobacco smoke, household income, and neighborhood income.
CONCLUSIONS:EIW may contribute to the disparities in urgent medical visits for asthma between high- and low-income neighborhoods. Physicians caring for asthmatics should consider EIW an indicator of risk for urgent medical visits.

Pediatrics. 2012 Dec 17. [Epub ahead of print]