哮喘联盟

   摘要
   背景：儿童哮喘表型反映了探索的潜在的发育机制，但对基于过敏性并发症的哮喘表型提示甚少。
   目标：研究旨在探究从出生到16岁的肺功能轨迹是否与伴过敏性鼻炎和特应性皮炎的哮喘表型有关。
   方法：利用潮汐流量循环，测定329例目标人群出生时的肺功能（z值），并在10岁和16岁时通过肺量检查测定肺功能。所有人群来源于在奥斯陆进行的“环境与儿童哮喘”出生队列研究。研究以0至2岁支气管阻塞的复发情况、2岁到10岁和10到16岁的哮喘发病情况为基础，对哮喘表型进行归类，并通过结合哮喘、特应性皮炎和/或10岁到16岁的过敏性鼻炎，对变应性致敏进行分层。对照组纳入231例无复发支气管阻塞或哮喘人群。
   结果：哮喘共病表型的肺功能轨迹显著不同，表现在FEV1、用力肺活量25％至75％的用力呼气流速、FEV1/用力肺活量显著不同（所有P<.0001）。患有哮喘、特应性皮炎和过敏性鼻炎人群从出生到16岁的肺功能显著受损。10至16岁患有哮喘或处于哮喘缓解期人群的肺功能轨迹与从未患有哮喘人群的肺功能轨迹相比，所有3项肺功能值显著不同（P<0.0001），但哮喘组之间无显著差异。变应性致敏不与哮喘表型的肺功能轨迹显著相关。
   结论：哮喘伴特应性皮炎和过敏性鼻炎患儿从出生到整个儿童期的肺功能轨迹受损，这似乎不太可能由变应性致敏引发，这可能意味着疾病在子宫内发病，在童年出现临床表现。
 

（苏楠 审校）
JAllergyClinImmunol.2014Jul3.pii:S0091-6749(14)00731-3.doi:10.1016/j.jaci.2014.05.020. [Epub ahead of print]

 

Lung function trajectories from birth through puberty reflect asthma phenotypes with allergic comorbidity.
 

Lødrup Carlsen KC1, Mowinckel P2, Hovland V2, Håland G2, Riiser A2, Carlsen KH2.
 

ABSTRACT
BACKGROUND: Childhood asthma phenotypes reflecting underlying developmental mechanisms are sought, with little information on asthma phenotypes based on allergic comorbidities.
OBJECTIVE: We asked whether lung function trajectories from birth to 16 years were associated with asthma phenotypes with comorbid allergic rhinitis and atopic dermatitis.
METHODS: Lung function (given as z scores) was measured at birth in 329 subjects in the "Environment and Childhood Asthma" birth cohort study in Oslo by using tidal flow volume loops, and at 10 and 16 years by using spirometry. Asthma phenotypes were classified on the basis of recurrent bronchial obstruction at 0 to 2 years, and asthma from the 2- to 10-year and 10- to 16-year intervals, and by combining asthma, atopic dermatitis, and/or allergic rhinitis from 10 to 16 years, stratifying for allergic sensitization. The reference group included 231 subjects without recurrent bronchial obstruction or asthma.
RESULTS: Lung function trajectories differed significantly for asthma comorbidity phenotypes for FEV1, forced expiratory flow at 25% to 75% of forced vital capacity, and FEV1/forced vital capacity (all P < .0001). Significant lung function impairment was observed from birth through 16 years among subjects with asthma, atopic dermatitis, and allergic rhinitis. Lung function trajectories in subjects with asthma at 10 to 16 years or asthma in remission differed significantly for all 3 spirometric values compared with the trajectories in those who never had asthma (P < .0001), but not between asthma groups. Allergic sensitization was not significantly associated with asthma phenotype lung function trajectories.
CONCLUSIONS: The trajectory consisting of impaired lung function from birth throughout childhood in children with asthma, atopic dermatitis, and allergic rhinitis appears less likely to be driven by allergic sensitization, and may imply disease onset in utero, with clinical presentation later in childhood.
 

JAllergyClinImmunol.2014Jul3.pii:S0091-6749(14)00731-3.doi:10.1016/j.jaci.2014.05.020. [Epub ahead of print]