Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age
Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age
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DOI：
10.1378/chest.127.2.502
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发表时间：
2005-02-01
期刊：
影响因子：
9.6
通讯作者：
Matthews, S
中科院分区：
文献类型：
--
作者：
Arshad, SH;Kurukulaaratchy, RJ;Matthews, S
研究目标：我们试图确定与10岁时喘息、哮喘和支气管高反应性(BHR)相关的早期生活因素(即前4岁)，比较它们对这些条件的相对影响。方法：在全人群出生队列研究(1,456名受试者)中，观察出生时以及1、2、4和10岁的儿童。前瞻性地收集了关于遗传和环境风险因素的信息。皮肤点刺试验在4岁时进行。在10岁时测量BHR时记录当前喘息(最近12个月)和当前诊断的哮喘(CDA)[即当前喘息和曾经诊断的哮喘受试者]。结果：母亲哮喘(优势比[OR]，2.08；95%可信区间[CI]，1.27~3.41)和父亲哮喘(OR，)对当前喘息有独立意义。2.12；95%CI 1.29~3.51)；2岁时反复胸部感染(OR 3.98；95%CI，2.36~6.70)；4岁时特应性反应(OR 3.69；95%CI 2.36~5.76)；4岁时患湿疹(OR 2.15；95%CI 1.24~3.73)；4岁时父母吸烟(OR 2.18；95%CI 1.25~3.81)。对于CDA，显著的影响因素是母亲哮喘(OR，2.26；95%CI，1.24~3.73)、父亲哮喘(OR，2.30；95%CI，1.17~4.52)、兄弟姐妹哮喘(OR，2.00；95%CI，1.16~3.43)、1岁时反复胸部感染(OR，2.67；95%CI，1.12~6.40)和2岁(OR，4.11；95%CI，2.06对S.IS)，4岁时有特应性(OR，7.22；95%CI，4.13~12.62)，1岁时父母吸烟(OR，1.99；95%CI，1.15~3.45)，男性(OR，1.72；95%CI，1.01~2.95)。在BHR中，4岁时的特应性(OR，5.38；95%CI，3.06~9.47)和出生时的高社会阶层(OR，2.03；95%CI，1.16~3.53)具有统计学意义。结论：哮喘遗传、易患早期特应性疾病、早期被动吸烟暴露、反复胸部感染是10岁时发生喘息和哮喘的重要影响因素。10岁的BHR具有较窄的风险分布，这表明影响喘息症状表达的因素可能不同于那些使患者易患BHR的因素。
Study objectives: We sought to identify early life factors (ie, first 4 years) associated with wheeze, asthma, and bronchial hyperresponsiveness (BHR) at age 10 years, comparing their relative influence for these conditions.Methods: Children were seen at birth, and at 1, 2, 4, and 10 years of age in a whole-population birth cohort study (1,456 subjects). Information was collected prospectively on genetic and environmental risk factors. Skin-prick testing was performed at 4 years of age. Current wheeze (in the last 12 months) and currently diagnosed asthma (CDA) [ie, current wheeze and ever-diagnosed asthmatic subject] were recorded at 10 years of age when BHR was measured at bronchial challenge. Independent significant risk factors for these outcomes were identified by logistic regression.Results: Independent significance for current wheeze occurred with maternal asthma (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.27 to 3.41) and paternal asthma (OR,. 2.12; 95% CI 1.29 to 3.51), recurrent chest infections at 2 years (OR, 3.98; 95% CI, 2.36 to 6.70), atopy at 4 years of age (OR, 3.69; 95% CI, 2.36 to 5.76), eczema at 4 years of age (OR, 2.15; 95% CI, 1.24 to 3.73), and parental smoking at 4 years of age (OR, 2.18; 95% CI, 1.25 to 3.81). For CDA, significant factors were maternal asthma (OR, 2.26; 95% CI, 1.24 to 3.73), paternal asthma (OR, 2.30; 95% CI, 1.17 to 4.52), and sibling asthma (OR, 2.00; 95% CI, 1.16 to 3.43), recurrent chest infections at I year of age (OR, 2.67; 95% CI, 1.12 to 6.40) and 2 years of age (OR, 4.11; 95% CI, 2.06 to S. IS), atopy at 4 years of age (OR, 7.22; 95% CI, 4.13 to 12.62), parental smoking at I year of age (OR, 1.99; 95% CI, 1.15 to 3.45), and male gender (OR, 1.72; 95% CI, 1.01 to 2.95). For BHR, atopy at 4 years of age (OR, 5.38; 95% CI, 3.06 to 9.47) and high social class at birth (OR, 2.03; 95% CI, 1.16 to 3.53) proved to be significant.Conclusions: Asthmatic heredity, predisposition to early life atopy, plus early passive smoke exposure and recurrent chest infections are important influences for the occurrence of wheeze and asthma at 10 years of age. BHR at 10 years of age has a narrower risk profile, suggesting that factors influencing wheezing symptom expression may differ from those predisposing the patient to BHR.