哮喘联盟

   摘要
   背景：很多学龄前儿童有喘息或咳嗽症状，但只有一部分会发展为哮喘。现有的预测工具很难在临床实践中得到应用或者具有方法学上的弱点。
   目的：我们力图寻找一种简单有力的方法以预测喘息或咳嗽的学龄前儿童在学龄期是否会发展为哮喘。
   方法：我们从一项英国莱斯特郡的人群基础队列研究中，选取因喘息或咳嗽就诊的1～3岁儿童纳入研究，并评估5年后哮喘患病率。我们只采用在基层医疗中方便评估的无创性预测工具：人口统计学和围产期的数据，湿疹，上下呼吸道症状和过敏家族史。我们用逻辑回归建模，采用最小绝对收缩和选择算子惩罚避免过拟合，然后使之简化为一种实用的工具。我们采用了内部校验法，并用分级布莱尔评分和受试者工作特性曲线下面积评估预测情况。
   结果：在1226例有随访信息的症状性儿童中，345例（28%）5年后发展为哮喘。本工具包括10个预测因素，总分在0～15之间：性别，年龄，不伴感冒的喘息，喘息频率，活动干扰，气促，运动相关和气源性致病原相关的喘息/咳嗽，湿疹和哮喘/支气管炎家族史。在内部校验模型和工具中，分级布莱尔评分分别为0.20和0.16，受试者工作特性曲线下面积分别为0.76和0.74。
   结论：本工具为症状性学龄前儿童提供了一种预测哮喘风险的简单、低成本和无创方法，并准备在其他人群中进行测试。

 

（刘国梁 审校）
J Allergy Clin Immunol. 2014Jan;133(1):111-118.e13.doi:10.1016/j.jaci.2013.06.002. Epub 2013 Jul 24.

 

A simple asthma prediction tool for preschool children with wheeze or cough.
 

Pescatore AM1, Dogaru CM1, Duembgen L2, Silverman M3, Gaillard EA3, Spycher BD1, Kuehni CE4.
 

Abstract
BACKGROUND: Many preschool children have wheeze or cough, but only some have asthma later. Existing prediction tools are difficult to apply in clinical practice or exhibit methodological weaknesses.
OBJECTIVE: We sought to develop a simple and robust tool for predicting asthma at school age in preschool children with wheeze or cough.
METHODS: From a population-based cohort in Leicestershire, United Kingdom, we included 1- to 3-year-old subjects seeing a doctor for wheeze or cough and assessed the prevalence of asthma 5 years later. We considered only noninvasive predictors that are easy to assess in primary care: demographic and perinatal data, eczema, upper and lower respiratory tract symptoms, and family history of atopy. We developed a model using logistic regression, avoided overfitting with the least absolute shrinkage and selection operator penalty, and then simplified it to a practical tool. We performed internal validation and assessed its predictive performance using the scaled Brier score and the area under the receiver operating characteristic curve.
RESULTS: Of 1226 symptomatic children with follow-up information, 345 (28%) had asthma 5 years later. The tool consists of 10 predictors yielding a total score between 0 and 15: sex, age, wheeze without colds, wheeze frequency, activity disturbance, shortness of breath, exercise-related and aeroallergen-related wheeze/cough, eczema, and parental history of asthma/bronchitis. The scaled Brier scores for the internally validated model and tool were 0.20 and 0.16, and the areas under the receiver operating characteristic curves were 0.76 and 0.74, respectively.
CONCLUSION: This tool represents a simple, low-cost, and noninvasive method to predict the risk of later asthma in symptomatic preschool children, which is ready to be tested in other populations.
 

J Allergy Clin Immunol. 2014Jan;133(1):111-118.e13.doi:10.1016/j.jaci.2013.06.002. Epub 2013 Jul 24.