哮喘联盟

   摘要
   目的：哮喘的季节性变化已广为人知，九月份最高发。本回顾性人群研究目的在于探究是否初级护理机构的大部分儿童哮喘存在上述季节性变化，并评估年龄、性别、城市/农村居住和人口对其的影响。
   方法：主要研究结果为家庭医生在2005～2009年间记录的哮喘急性发作的诊断以及哮喘药物处方。通过Clalit医疗服务电子病例数据库中的“每周诊断”项对上述资料进行分析。建立回归模型以评估长期趋势、季节性与年龄组的相关强度，以对哮喘急性发作的发生做出相关解释。
   结果：共纳入919 873例年龄在2～15岁的儿童。其中82 234(8.9%)患有哮喘，男孩占61.6%、女孩占38.4%；49.1%年龄为2～5岁，24.1%为6～9岁，28.6%为10～15岁。研究发现，与8月份相比，9月份(37～39周 vs 34～36周)儿童哮喘急性发作率增加2.01倍，哮喘支气管扩张剂药物处方增加2.28倍。在2～5岁(比值比，2.15)和6～11岁(1.90倍)儿童中，学校的开放性与哮喘相关的初级护理医师访问率具有最大的相关性。青少年(年龄12～15岁)具有较小的峰值(1.81倍)。在深秋有第二个上升，波动持续整个冬季，夏季为低谷。
   结论：夏季后返校显著增加哮喘急性发作风险以及计划外初级护理医师访问量。
 

（苏楠 审校）
Pediatrics. 2014 Mar 10. [Epub ahead of print]

 

Seasonality of Asthma: A Retrospective Population Study.
 

Cohen HA1, Blau H, Hoshen M, Batat E, Balicer RD.
 

Abstract
OBJECTIVES: Seasonal variations in asthma are widely recognized, with the highest incidence during September. This retrospective population study aimed to investigate whether this holds true in a large group of asthmatic children in primary care and to assess the impact of age, gender, urban/rural living, and population sector.
METHODS: The key study outcomes were the diagnosis of asthma exacerbations and asthma medication prescriptions, recorded by family physicians during 2005 to 2009. These were analyzed by "week of diagnosis" in Clalit Health Services' electronic medical record database. Regression models were built to assess relative strength of secular trends, seasonality, and age-group in explaining the incidence of asthma exacerbations.
RESULTS: A total of 919 873 children aged 2 to 15 years were identified. Of these, 82 234 (8.9%) were asthmatic, 61.6% boys and 38.4% girls; 49.1% aged 2 to 5 years, 24.1% 6 to 9 years, and 26.8% 10 to 15 years. We observed a 2.01-fold increase in pediatric asthma exacerbations and 2.28-fold increase in prescriptions of asthma bronchodilator medications during September (weeks 37-39 vs weeks 34-36) compared with August. The association between the opening of school and the incidence of asthma-related visits to the primary care physician was greatest in children aged 2 to 5 years (odds ratio, 2.15) and 6 to 11 years (1.90-fold). Adolescents (age 12-15 years) had a lesser peak (1.81-fold). In late fall there was a second rise, lasting with fluctuations throughout winter, with a trough in summer.
CONCLUSIONS: Returning to school after summer is strongly associated with an increased risk for asthma exacerbations and unscheduled visits to the primary care physician.
 

Pediatrics. 2014 Mar 10. [Epub ahead of print]