哮喘联盟

   摘要
   目的：确定哮喘相关因素与镰状细胞性贫血(SCA)发生率增加的相关性。
   研究设计：SCA儿童(N=187;平均年龄9.6years,48%男性)分为“哮喘组”(n=53)与“无哮喘组”(n=134)，“哮喘组”是基于父母报告的医师诊断加上哮喘药物的处方，“无哮喘组”则无这些特征。前瞻性收集疼痛和急性胸部综合征(ACS)事件。
   结果：多因素logistic回归模型确定了3个与哮喘相关因素：父母亲哮喘(P=.006)，喘息导致的呼吸短促(P=.001)，和运动后喘息(P<.001)。当≥2个特征出现时，模型灵敏度为100%。当无任何特征出现时，模型灵敏度为0%。当只有一个特征出现时，模型灵敏度也为0%，且皮肤敏感试验阳性、肺功能检查显示气道阻塞和支气管舒张反应中存在≥2个，并没有改善临床效用。哮喘儿童ACS发生率显著高于无哮喘儿童(发生率比 2.21, CI 1.31-3.76)，但疼痛率无差异(发生率比 1.28, CI 0.78-2.10)。
   结论：SCA儿童并且父母中有一个患有哮喘和特定的喘息症状是区分有无父母报告医师诊断为哮喘以及确定ACS事件更高风险儿童最好的特征。哮喘治疗在预防SCA发病率中的价值尚需进一步研究。
 

（林江涛 审校）
J Pediatr. 2013 Dec 31. pii: S0022-3476(13)01469-8.doi:10.1016/j.jpeds.2013.11.034. [Epub ahead of print]


 

Wheezing Symptoms and Parental Asthma Are Associated with a Physician Diagnosis of Asthma in Children with Sickle Cell Anemia.
 

Strunk RC1, Cohen RT2, Cooper BP3, Rodeghier M4, Kirkham FJ5, Warner JO6, Stocks J5, Kirkby J5, Roberts I6, Rosen CL7, Craven DI7, Debaun MR8; Sleep Asthma Cohort Investigative Team.
 

Abstract
OBJECTIVE: To identify factors associated with asthma associated with increased sickle cell anemia (SCA).
STUDY DESIGN: Children with SCA (N = 187; mean age 9.6 years, 48% male) were classified as having "asthma" based on parent report of physician diagnosis plus prescription of asthma medication (n = 53) or "no asthma" based on the absence of these features (n = 134). Pain and acute chest syndrome (ACS) events were collected prospectively.
RESULTS: Multiple variable logistic regression model identified 3 factors associated with asthma: parent with asthma (P = .006), wheezing causing shortness of breath (P = .001), and wheezing after exercise (P < .001). When ≥2 features were present, model sensitivity was 100%. When none of the features were present, model sensitivity was 0%. When only 1 feature was present, model sensitivity was also 0%, and presence of ≥2 of positive allergy skin tests, airway obstruction on spirometry, and bronchodilator responsiveness did not improve clinical utility. ACS incident rates were significantly higher in individuals with asthma than in those without asthma (incident rate ratio 2.21, CI 1.31-3.76), but pain rates were not (incident rate ratio 1.28, CI 0.78-2.10).
CONCLUSIONS: For children with SCA, having a parent with asthma and specific wheezing symptoms are the best features to distinguish those with and without parent report of a physician diagnosis of asthma and to identify those at higher risk for ACS events. The value of treatment for asthma in the prevention of SCA morbidity needs to be studied.
 

J Pediatr. 2013 Dec 31. pii: S0022-3476(13)01469-8.doi:10.1016/j.jpeds.2013.11.034. [Epub ahead of print]