Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children
Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children
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DOI：
10.1136/thx.2005.042523
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发表时间：
2006-05-01
期刊：
影响因子：
10
通讯作者：
Custovic, A
中科院分区：
文献类型：
--
作者：
Murray, CS;Poletti, G;Custovic, A
背景：哮喘急性发作是儿童入院的最常见原因。进行了一项研究，以调查过敏原暴露的重要性，在敏感的个人结合病毒感染和其他潜在的可改变的危险因素，促使哮喘住院children.Methods：84名3 - 17岁的儿童入院超过1年的时间内与急性哮喘加重（AA）的年龄和性别相匹配的两个对照组：稳定的哮喘患者（SA）和因非呼吸系统疾病（IC）入院的儿童。通过问卷调查和过敏原致敏性，家庭过敏原暴露，花粉暴露，呼吸道病毒infection.Results的测定评估风险因素：几个不可改变的因素（特应性，哮喘的持续时间）与风险增加。在可改变的因素中，宠物所有权、住房特征和父母吸烟在各组之间没有差异。AA组中常规吸入性皮质类固醇治疗显著低于SA组（OR 0.2，95% CI 0.1 - 0.6; p = 0.002）。与SA组（18%和48%）和IC组（17%和28%;均p < 0.001）相比，AA组中病毒感染（44%）和致敏以及高度暴露于致敏变应原（76%）的比例显著更高。在一个多因素条件Logistic回归分析（AA v SA）中，过敏原致敏和暴露或单独的病毒检测不再与入院独立相关。然而，病毒检测和致敏与高变应原暴露的结合显著增加了入院的风险（OR 19.4，95% CI 3.7 ~ 101.5，p < 0.001）。结论：过敏性哮喘儿童的自然病毒感染和真实的生活变应原暴露增加了入院的风险。预防病情加重的策略需要解决这些因素。
Background: Asthma exacerbation is the most common cause of hospital admission in children. A study was undertaken to investigate the importance of allergen exposure in sensitised individuals in combination with viral infections and other potentially modifiable risk factors precipitating asthma hospital admission in children.Methods: Eighty four children aged 3 - 17 years admitted to hospital over a 1 year period with an acute asthma exacerbation (AA) were matched for age and sex with two control groups: stable asthmatics (SA) and children admitted to hospital with non-respiratory conditions (IC). Risk factors were assessed by questionnaires and determination of allergen sensitisation, home allergen exposure, pollen exposure, and respiratory virus infection.Results: Several non-modifiable factors (atopy, duration of asthma) were associated with increased risk. Among the modifiable factors, pet ownership, housing characteristics, and parental smoking did not differ between the groups. Regular inhaled corticosteroid treatment was significantly less common in the AA group than in the SA group (OR 0.2, 95% CI 0.1 to 0.6; p = 0.002). A significantly higher proportion of the AA group were virus infected ( 44%) and sensitised and highly exposed to sensitising allergen (76%) compared with the SA (18% and 48%) and IC groups (17% and 28%; both p < 0.001). In a multiple conditional logistic regression ( AA v SA), allergen sensitisation and exposure or virus detection alone were no longer independently associated with hospital admission. However, the combination of virus detection and sensitisation with high allergen exposure substantially increased the risk of admission to hospital ( OR 19.4, 95% CI 3.7 to 101.5, p < 0.001).Conclusions: Natural virus infection and real life allergen exposure in allergic asthmatic children increase the risk of hospital admission. Strategies for preventing exacerbations will need to address these factors.