Predictors of the new onset of wheezing among middle-aged and older men. The Normative Aging Study.
Predictors of the new onset of wheezing among middle-aged and older men. The Normative Aging Study.
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中老年男性新发喘息的预测因素。
DOI：
10.1164/ajrccm/147.2.367
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Weiss,ST
中科院分区：
文献类型：
--
作者：
Sparrow,D;O'Connor,GT;Basner,RC;Rosner,B;Weiss,ST
在一项前瞻性队列研究中，624名最初否认有喘息或哮喘病史的中老年男性检查了可能与喘息症状发展相关的特征。初步评估包括肺活量测定、甲胆碱刺激试验、常见空气过敏原过敏皮肤试验、血清总ge浓度、血白细胞计数、血嗜酸性粒细胞计数和体位心率变化（站立减仰卧）。随访3年后，通过问卷评估喘息症状的存在或不存在。使用多元逻辑回归来检验初始特征作为后续喘息的预测因子。当前吸烟是新发作喘息的最强独立预测因子（校正OR为14.3；95%可信区间（CI）为3.9 ~ 52.3）。发生新喘息的风险也随着年龄（校正OR， 1.6; 95% CI，相隔10年的个体受试者0.9 - 2.9）和初始检查时体位心率变化（校正OR， 1.8; 95% CI，差异10次/分的个体受试者1.1 - 3.0）的增加而增加。在非吸烟者中观察到较高的甲胆碱气道反应性（PD2oFE\4~ 16.8 umol vs PD2oFE\4 bb0 16.8 umol）与随后发生的喘息之间的显著关联（校正OR为5.2；95% CI为2.0 ~ 13.6），但在当前吸烟者中没有观察到。其他基线变量与发生喘息症状的风险没有独立的关系。这些数据表明，目前吸烟、年龄、非特异性气道反应性和自主神经功能改变与中老年男性发生喘息症状的风险独立相关。非特异性气道反应性增高是哮喘的典型特征(1)。它也可能是亚临床疾病的标志，或者可能是哮喘发生之前和诱发哮喘的独立特征。家庭研究表明，哮喘患者的非哮喘亲属比一般人群表现出更大的气道反应性(2)，这表明高反应性的遗传易感性可能是哮喘的一个危险因素。对儿童(3)和对豚草敏感的年轻人(4)的研究表明，非哮喘患者气道反应性增高可能预示哮喘的发展。
Characteristics potentially associated with the development of wheeze symptoms were examined in a prospective cohort study of 624 middle-aged and older men who initially denied any history of wheezing or asthma. Initial evaluation included spirometry, methacholine challenge testing, allergy skin testing with common aeroallergens, serum totallgE concentration, blood leukocyte count, blood eosinophil count, and postural heart rate change (standing minus supine). The presence or absence of wheezing symptoms at follow-up 3 yr later was assessed by questionnaire. Multiple logistic regression was used to examine initial characteristics as predictors of subsequent wheezing. Current smoking was the strongest independent predictor of the new onset of wheezing (adjusted OR, 14.3; 95% confidence interval (CI), 3.9 to 52.3). The risk of developing new wheezing also increased with age (adjusted OR, 1.6; 95% CI, 0.9 to 2.9 comparing individual subjects 10 yr apart) and postural heart rate change at the initial examination (adjusted OR, 1.8; 95% CI, 1.1 to 3.0 comparing individual subjects differing by 10 beats/min). A significant association between greater methacholine airway responsiveness (PD2oFE\4~ 16.8 umol versus PD2oFE\4> 16.8 umol) and the subsequent development of wheezing was observed among nonsmokers (adjusted OR, 5.2; 95% CI, 2.0 to 13.6) but not among current smokers. Other baseline variables were not independently related to the risk of developing wheezing symptoms. These data suggest that current smoking, age, nonspecific airway responsiveness, and altered autonomic function are independently related to the risk of developing wheezing symptoms in middle-aged and older men.Heightened nonspecific airway responsiveness is a defining feature of asthma (1). It may also be a marker of subclinical disease or, possibly, an independent characteristic that precedes and predisposes to the development of asthma. Family studies indicate that nonasthmatic relatives of asthmatics display greater airway responsiveness than does the general population (2), suggesting that a genetic predisposition to hyperresponsiveness may be a risk factor for asthma. Studies of children (3) and ragweedsensitive young adults (4) have suggested that heightened airway responsiveness in nonasthmatic persons may predict the development of asthma.