Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma.
Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma.
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DOI：
10.1056/nejmoa1513737
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发表时间：
2016-05-12
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影响因子：
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通讯作者：
Strunk RC
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作者：
McGeachie MJ;Yates KP;Zhou X;Guo F;Sternberg AL;Van Natta ML;Wise RA;Szefler SJ;Sharma S;Kho AT;Cho MH;Croteau-Chonka DC;Castaldi PJ;Jain G;Sanyal A;Zhan Y;Lajoie BR;Dekker J;Stamatoyannopoulos J;Covar RA;Zeiger RS;Adkinson NF;Williams PV;Kelly HW;Grasemann H;Vonk JM;Koppelman GH;Postma DS;Raby BA;Houston I;Lu Q;Fuhlbrigge AL;Tantisira KG;Silverman EK;Tonascia J;Weiss ST;Strunk RC
追踪儿童持续性哮喘患者肺功能的生长和下降的纵向测量可能揭示哮喘和随后的慢性气流阻塞之间的联系。我们根据肺功能生长和下降的四种特征模式对哮喘儿童进行分类，这些模式基于显示1秒用力呼气量（FEV 1）的图表，代表从儿童期到成年期进行的肺功能测定。与异常模式相关的风险因素也进行了检查。为了定义正常值，我们使用了来自国家健康和营养检查调查中没有哮喘的参与者的FEV 1值。在684名研究参与者中，170名（25%）的肺功能增长模式正常，没有早期下降，514名（75%）的肺功能增长模式异常：176名（26%）增长减慢和早期下降，160名（23%）仅增长减慢，178名（26%）正常增长和早期下降。FEV 1基线值较低、支气管扩张剂反应较小、基线时气道高反应性和男性与生长减慢相关（所有比较P<0.001）。在最后一次肺量计测量时（平均[±SD]年龄，26.0±1.8岁），73名参与者（11%）符合慢性阻塞性肺疾病全球倡议肺功能损害的肺功能测定标准，与慢性阻塞性肺疾病（COPD）一致;这些参与者更可能有一个减少的增长模式比正常模式（18%比3%，P<0.001）。儿童期肺功能损害和男性是肺功能生长和下降的异常纵向模式的最重要的预测因素。患有持续性哮喘和肺功能下降的儿童在成年早期发生固定气流阻塞和可能的COPD的风险增加。（由帕克B资助。弗朗西斯基金会等; ClinicalTrials.gov编号，NCT 00000575。）
Tracking longitudinal measurements of growth and decline in lung function in patients with persistent childhood asthma may reveal links between asthma and subsequent chronic airflow obstruction. We classified children with asthma according to four characteristic patterns of lung-function growth and decline on the basis of graphs showing forced expiratory volume in 1 second (FEV1), representing spirometric measurements performed from childhood into adulthood. Risk factors associated with abnormal patterns were also examined. To define normal values, we used FEV1 values from participants in the National Health and Nutrition Examination Survey who did not have asthma. Of the 684 study participants, 170 (25%) had a normal pattern of lung-function growth without early decline, and 514 (75%) had abnormal patterns: 176 (26%) had reduced growth and an early decline, 160 (23%) had reduced growth only, and 178 (26%) had normal growth and an early decline. Lower baseline values for FEV1, smaller bronchodilator response, airway hyperresponsiveness at baseline, and male sex were associated with reduced growth (P<0.001 for all comparisons). At the last spirometric measurement (mean [±SD] age, 26.0±1.8 years), 73 participants (11%) met Global Initiative for Chronic Obstructive Lung Disease spirometric criteria for lung-function impairment that was consistent with chronic obstructive pulmonary disease (COPD); these participants were more likely to have a reduced pattern of growth than a normal pattern (18% vs. 3%, P<0.001). Childhood impairment of lung function and male sex were the most significant predictors of abnormal longitudinal patterns of lung-function growth and decline. Children with persistent asthma and reduced growth of lung function are at increased risk for fixed airflow obstruction and possibly COPD in early adulthood. (Funded by the Parker B. Francis Foundation and others; ClinicalTrials.gov number, NCT00000575.)