Asthma and lung function 20 years after wheezing in infancy - Results from a prospective follow-up study
Asthma and lung function 20 years after wheezing in infancy - Results from a prospective follow-up study
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DOI：
10.1001/archpedi.158.11.1070
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发表时间：
2004-11-01
影响因子：
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通讯作者：
Korppi, M
中科院分区：
文献类型：
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作者：
Piippo-Savolainen, E;Remes, S;Korppi, M
目的：为了确定结果，直到成年后喘息在婴儿期，比较肺炎在婴儿期和对照组。设计：一个18至20年的前瞻性队列研究。设置：儿科部门在一所大学医院，提供初级医院护理的一个明确的人口。患者：54名2岁以下的儿童因细支气管炎住院，34名2岁以下的儿童因肺炎住院，45名对照儿童没有早期喘息或住院，主要指标：哮喘症状和药物治疗的问卷调查、体格检查、肺量测定法（FVS）、乙酰甲胆碱吸入激发试验（MIC）、家庭呼气峰流速（PEF）监测和常见吸入性过敏原皮肤点刺试验（SPT）。2种哮喘定义为医生诊断的哮喘和既往诊断的哮喘伴近期哮喘症状结果：根据这两种定义，哮喘的发病率为30%（比值比[OR]，3.37; 95%置信区间[CI]，1.12-10.10），41%（OR 1.38; 95%CI，0.37-5.21）在毛细支气管炎组中，15%肺炎组的阳性率为24%（OR，2.07; 95%CI，0.59-7.22），对照组为11%。毛细支气管炎后FVS值分别为用力肺活量（FVC）占预计值的108%（SD，13%），1秒用力呼气量占预计值的98%（SD，12%），1秒用力呼气量除以FVC占预计值的91%（SD，13%），1秒用力呼气量除以FVC占预计值的91%（SD，12%）。（SD，7.6%）; 50% FVC时的呼气中段流速，74%（SD，19%）; 25% FVC时的呼气中段流速，74%（SD，22%）。毛细支气管炎组52名受试者中有25名（48%）、肺炎组31名受试者中有13名（42%）、对照组44名受试者中有14名（32%）出现MIC支气管反应性。3组中特应性（阳性SPT）的患病率为48%至63%。在Logistic回归调整过敏和吸烟，婴儿毛细支气管炎是一个独立的危险因素哮喘的两个definition.Conclusion：哮喘的风险增加持续到成年后毛细支气管炎在婴儿期。
Objective: To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls.Design: An 18- to-20-year prospective cohort study.Setting: Pediatric department at a university hospital, providing primary hospital care for a defined population.Patients: Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years.Main Outcome Measures: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included).Results: By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% Cl, 1.87-16.14) and in 24% (OR, 2.07; 95% Cl, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions.Conclusion: The increased risk for asthma persists until adulthood after bronchiolitis in infancy.