Characterization of wheezing phenotypes in the first 10 years of life
Characterization of wheezing phenotypes in the first 10 years of life
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DOI：
10.1046/j.1365-2222.2003.01657.x
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发表时间：
2003-05-01
影响因子：
6.1
通讯作者：
Arshad, SH
中科院分区：
文献类型：
--
作者：
Kurukulaaratchy, RJ;Fenn, MH;Arshad, SH
背景：儿童喘息性疾病有不同的表型。目的利用健康结局以及特应性、肺功能和支气管高反应性的测量来确定儿童喘息的表型特征。方法前瞻性研究全人群出生队列(n=1456)儿童喘息的自然病史。在1岁、2岁、4岁和10岁的儿童完成问卷调查，并前瞻性地收集用于定义喘息表型的数据。对不良健康结局加上肺活量、支气管高反应性、10岁时的血清IgE测定以及4岁和10岁时的皮试致敏对喘息表型进行评估。结果表型分析表明，37%的早期喘息者(4岁起病)在10岁时仍有喘息。这些持续性喘息者在早期表现出更多的医生诊断的哮喘(2岁时P<；0.005)比早期暂时性喘息者(4岁起病时有一过性喘息)要多得多。总体而言，与早期暂时性喘息症相比，他们经历了更多的住院(P=0.024)、专科转诊(P=0.009)以及吸入(P<；0.001)和口服类固醇(P<；0.001)的使用。与早期短暂性喘息者相比，他们还表现出更强的支气管高反应性(P<；0.001)。然而，与非喘息组相比，两组早期喘息者在10年后都显示出基线肺功能受损：FEV1(P<；0.029)和FEV1/FVC比值(P<；0.001)伴持续喘息，PEF(P=0.036)伴早期短暂性喘息。迟发性喘息者(5岁起病)的BHR与持续性喘息者相似，但在10岁时肺功能维持正常，不良健康后果的累积发生率低于持续性喘息者。结论儿童早期发作的持续性喘息者在出生后头10年的发病率很高，与10岁时高水平的特应性、支气管高反应性和肺功能受损有关。在生命的第一个十年里，迟发性的喘息可能会潜藏在随后类似的重大疾病中。
Background Childhood wheezing illnesses are characterized into different phenotypes. However, severity of the disease associated with these phenotypes has not been extensively studied.Objectives To determine characteristics of childhood wheezing phenotypes in the first decade of life using health outcomes plus measurements of atopy, lung function and bronchial hyper-responsiveness.Methods A whole population birth cohort (n = 1456) was prospectively studied to examine the natural history of childhood wheezing. Children were seen at 1, 2, 4 and 10 years for questionnaire completion and prospectively collected data used to define wheezing phenotypes. Assessment was made of adverse health outcomes plus spirometry, bronchial hyper-responsiveness, serum IgE measurement at 10 years and skin test sensitization at both 4 and 10 years for wheezing phenotypes.Results Phenotypic analysis identified that 37% early life wheezers (symptom onset by age 4 years) still wheezed at 10 years. These persistent wheezers showed significantly more physician-diagnosed asthma in early life (P < 0.005 at 2 years) than early transient wheezers (wheezing transiently with onset by age 4 years). Overall they experienced greater multiple hospital admissions (P = 0.024), specialist referral (P = 0.009) and use of inhaled (P < 0.001) and oral steroids (P < 0.001) than early transient wheezers. They also demonstrated enhanced bronchial hyper-responsiveness compared with early transient wheezers (P < 0.001). However, both groups of early life wheezers showed impairment of baseline lung function at 10 years in comparison with non-wheezers: FEV1 (P < 0.029) and FEV1 /FVC ratio (P < 0.001) with persistent wheeze and PEF (P = 0.036) with early transient wheeze. Late-onset wheezers (onset from 5 years onwards) had similar BHR to persistent wheezers but maintained normal lung function at age 10 and had lower cumulative prevalence of adverse health outcomes than persistent wheezers.Conclusions Persistent wheezing with early childhood onset is associated with substantial morbidity in the first decade of life in association with high levels of atopy, bronchial hyper-responsiveness and impaired lung function at 10 years of age. Late-onset wheezing in the first decade of life could harbour potential for similarly significant disease subsequently.