A comparison of the clinical characteristics of children and adults with severe asthma
A comparison of the clinical characteristics of children and adults with severe asthma
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DOI：
10.1378/chest.124.4.1318
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发表时间：
2003-10-01
期刊：
影响因子：
9.6
通讯作者：
Spahn, JD
中科院分区：
文献类型：
--
作者：
Jenkins, HA;Cherniack, R;Spahn, JD
目的：本研究旨在更好地确定儿童和成人严重哮喘的临床特征，并评估哮喘持续时间对疾病严重程度多个参数的影响。设计：回顾性分析前瞻性收集的275例患者的数据（125名儿童）患有严重哮喘，他们被纳入三级哮喘转诊中心。人口统计学、肺功能对所有患者进行肺功能测定和体箱体积描记法（body box plethysmography）、糖皮质激素（GC）药代动力学研究和淋巴细胞刺激试验。儿童可能需要高剂量吸入性GC治疗和长期口服GC治疗，并且之前有插管，然而，他们的气流限制明显较少（平均值[+/-SEM]（.）FEV 1，分别为74.0 +/- 2.1%预测值vs 57.1 +/- 1.8%预测值; p < 0.0001），气流阻力较小（平均气道阻力，分别为140.3 +/- 8.5%预测值vs 311 +/- 18%预测值; p < 0.0001）和更大的肺容量（平均总肺容量，分别为116.4 ± 1.6%预测值和105.3 ± 1.8%预测值; p < 0.0001）。儿童更有可能是男性，并在体外对GC表现出更大的反应性。在儿童和儿童期哮喘发作的成人中，肺功能损害与哮喘持续时间相关，而在成人发作哮喘患者中，疾病严重程度与哮喘持续时间无关。尽管疾病持续时间的显着差异，成人发作的哮喘患者同样损害肺功能相比，成人长期asthma.Conclusions：严重哮喘的儿童往往是男性，有不太严重的气流阻塞，并显示更大的反应GC体外相比，成人。在这组儿童中，症状和发作性肺功能急性下降可能先于慢性气流限制。因此，可能更有意义的是跟踪儿童肺功能随时间的恶化。最后，在儿童期发作哮喘的儿童和成人中，疾病严重程度与疾病持续时间相关，但在成年期发作哮喘的患者中则不相关。
Objectives: This study sought to better define the clinical characteristics of severe asthma in both children and adults, and to evaluate the effect of asthma duration on multiple parameters of disease severity.Design: Retrospective analysis of prospectively collected data on 275 patients (125 children) with severe asthma who were admitted to a tertiary asthma referral center.Methods: Demographics, lung function (ie, spirometry and body box plethysmography), glueocorticoid (GC) pharmacokinetic studies, and lymphocyte stimulation assays were performed on all patients.Results: Children were as likely to require therapy with high-dose inhaled GCs and long-term therapy with oral GCs, and to have had a prior intubation, yet they had significantly less airflow limitation (mean [+/-SEM] (.) FEV1, 74.0 +/- 2.1% predicted vs 57.1 +/- 1.8% predicted, respectively; p < 0.0001), less resistance to airflow (mean airway resistance, 140.3 +/- 8.5% predicted vs 311 +/- 18% predicted, respectively; p < 0.0001), and larger lung volumes (mean total lung capacity, 116.4 1.6% predicted vs 105.3 +/- 1.8% predicted, respectively; p < 0.0001) compared to adults. Children were more likely to be male and to display greater responsiveness to GCs in vitro. Lung function impairment was associated with asthma duration in children and in adults with onset of asthma in childhood, while there was no relationship between disease severity and asthma duration among those with adult-onset asthma. Despite significant differences in disease duration, patients with adult-onset asthma had equally compromised lung function compared to adults with long-standing asthma.Conclusions: Children with severe asthma tended to be male, to have less severe airflow obstruction, and to display greater responsiveness to GCs in vitro compared to adults. Symptoms and episodic acute declines in lung function may precede chronic airflow limitation in this group of children. As such, it may be more relevant to follow the deterioration in lung function over time in children. Finally, disease severity in children and adults whose onset of asthma occurred in childhood was related to disease duration, but not in patients with onset of asthma in adulthood.