Pneumonia in Childhood and Impaired Lung Function in Adults: A Longitudinal Study
Pneumonia in Childhood and Impaired Lung Function in Adults: A Longitudinal Study
复制标题
DOI：
10.1542/peds.2014-3060
复制
发表时间：
2015-04-01
期刊：
影响因子：
8
通讯作者：
Martinez, Fernando D.
中科院分区：
文献类型：
--
作者：
Chan, Johnny Y. C.;Stern, Debra A.;Martinez, Fernando D.
背景技术背景：在有早期下呼吸道疾病（LRI）（包括肺炎）病史的儿童中，已报告肺功能下降和哮喘患病率增加。这些协会是否持续到成年期尚未established.METHODS：作为前瞻性图森儿童呼吸研究的一部分，LRI在生命的前3年由儿科医生确定。在11岁、16岁、22岁和26岁时进行肺量测定。在11岁、13岁、16岁、18岁、22岁、24岁、26岁和29岁时确定了前一年哮喘/喘息的发生率。纵向随机效应模型和广义估计方程用于评估LRI与肺功能和哮喘的关系。与没有早期LRI的参与者相比，肺炎患者随后的肺功能损害最严重，从11岁到26岁，使用支气管扩张剂前和使用支气管扩张剂后FEV 1：FVC比值的平均6个SE缺损分别为-3.9% +/-0.9%（P <.001）和-2.5% +/-0.8%（P = .001）。在相同年龄范围内，肺炎与哮喘（比值比[OR]：1.95; 95%置信区间[CI]：1.11-3.44）和喘息（OR：1.94; 95% CI：1.28-2.95）风险增加相关。早期非肺炎LRI与使用支气管扩张剂前FEV 1（-62.8 +/- 27.9mL，P = 0.024）和FEV 1：FVC比值（-1.1 +/-0.5%，P = 0.018）轻度受损和喘息（OR：1.37; 95%CI：1.09-1.72）相关。结论：早期肺炎与哮喘和气道功能受损相关，使用支气管扩张剂可部分逆转，并持续至成年。早期肺炎可能是成人慢性阻塞性肺疾病的主要危险因素。
BACKGROUND: Diminished lung function and increased prevalence of asthma have been reported in children with a history of early lower respiratory illnesses (LRIs), including pneumonia. Whether these associations persist up to adulthood has not been established.METHODS: As part of the prospective Tucson Children's Respiratory Study, LRIs during the first 3 years of life were ascertained by pediatricians. Spirometry was performed at ages 11, 16, 22, and 26 years. The occurrence of asthma/wheeze during the previous year was ascertained at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relation of LRIs to lung function and asthma.RESULTS: Compared with participants without early-life LRIs, those with pneumonia had the most severe subsequent lung function impairment, with mean 6 SE deficits of -3.9% +/- 0.9% (P < .001) and -2.5% +/- 0.8% (P = .001) for pre- and post-bronchodilator FEV1:FVC ratio from age 11 to 26 years, respectively. Pneumonia was associated with increased risk for asthma (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.11-3.44) and wheeze (OR: 1.94; 95% CI: 1.28-2.95) over the same age range. Early non-pneumonia LRIs were associated with mildly impaired pre-bronchodilator FEV1 (-62.8 +/- 27.9mL, P = .024) and FEV1:FVC ratio (-1.1 +/- 0.5%, P = .018), and wheeze (OR: 1.37; 95% CI: 1.09-1.72).CONCLUSIONS: Early pneumonia is associated with asthma and impaired airway function, which is partially reversible with bronchodilators and persists into adulthood. Early pneumonia may be a major risk factor for adult chronic obstructive pulmonary disease.