Predicting asthma outcomes
Predicting asthma outcomes
复制标题
DOI：
10.1016/j.jaci.2015.04.048
复制
发表时间：
2015-10-01
影响因子：
14.2
通讯作者：
Sears, Malcolm R.
中科院分区：
文献类型：
--
作者：
Sears, Malcolm R.
本文综述了从儿童早期到成年期喘息和哮喘缓解或持续的预测因素。儿童早期喘息是常见的，但预测谁会缓解或有持续的儿童哮喘仍然很困难。通过将父母的哮喘史和选定的婴儿生物标志物添加到复发性喘息史中，哮喘预测指数及其随后的修改提供了比简单地观察复发性喘息更好的持续性预测。致敏，特别是对多种过敏原的致敏，增加了经典儿童哮喘发展的可能性。男性受试者和疾病较轻（症状较轻且较不频繁）、特应性致敏较轻、气道高反应性程度较轻且无合并过敏性疾病的受试者更可能缓解。相反，持续性与过敏性致敏、更频繁和更严重的症状、异常肺功能和更大程度的气道高反应性密切相关。遗传风险评分可能比家族史更准确地预测持久性。已确诊的成人哮喘的缓解远不如儿童和青少年时期的缓解常见。肺功能丧失可在生命早期开始，并可持续至儿童期和青春期。尽管治疗控制症状和恶化，哮喘的结果似乎很大程度上抵抗药物治疗。
This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.