Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study.
Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study.
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DOI：
10.1016/s0140-6736(08)61447-6
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发表时间：
2008-09-20
期刊：
影响因子：
168.9
通讯作者：
Martinez, Fernando D.
中科院分区：
文献类型：
--
作者：
Stern, Debra A.;Morgan, Wayne J.;Halonen, Marilyn;Wright, Anne L.;Martinez, Fernando D.
哮喘的发病率在成年早期增加，但性别和早期生活因素在确定年轻人新诊断的哮喘中的相对影响尚不清楚。健康新生儿（n=1246）入组图森儿童呼吸研究。父母的特征，早期生活喘息表型，气道功能和支气管高反应性冷干燥空气和致敏链格孢菌的年龄6岁。在22岁时测定医生诊断的慢性和新诊断的哮喘和气道功能。16至22岁之间哮喘的平均发病率为每千人年12.6例。在22岁的所有活动性哮喘病例中，有四分之一是新诊断的，其中71%是女性。22岁时男性哮喘缓解率较高（p=0.008）。诊断时的年龄与22岁时的FEV 1/FVC比值呈线性相关。在22岁时，晚发性（多项比值比[M-OR]= 7.4 [95%CI：3.9，14]）和早期持续性喘息（M-OR=14.0 [6.8，28]）、对链格孢属的敏感性（M-OR=3.6 [2.1，6.4]）、6岁时的气道功能低下（M-OR=2.1 [1.1，3.9]）和6岁时的支气管高反应性（M-OR=4.5 [1.9，10]）与慢性哮喘独立相关。支气管高反应性（M-OR=6.9 [2.3，21]）、6岁时气道功能低下（M-OR=2.8 [1.1，6.9]）、晚发性（M-OR=4.6 [1.7，12]）和持续喘息（M-OR=4.0 [1.2，14]）可预测22岁时新诊断的哮喘。在年轻的成年人中，女性优先发展为新诊断的哮喘，但大多数人在早年就已经有喘息症状，并在6岁时出现支气管高反应性。早期成人哮喘发作的根源可以在学龄前找到。
Incidence of asthma increases during the early adult years, but the relative influence of sex and early life factors in determining newly diagnosed asthma in young adults is unknown. Healthy newborns (n=1246) were enrolled in the Tucson Children's Respiratory Study. Parental characteristics early life wheezing phenotypes, airway function and bronchial hyperresponsiveness to cold dry air and sensitization to Alternaria were determined by age 6 years. Physician diagnosed asthma, both chronic and newly diagnosed, and airway function were determined at age 22 years. Average incidence of asthma between 16 and 22 years was 12.6 per thousand person-years. One fourth of all cases of active asthma at age 22 were newly diagnosed, of which 71% were females. Asthma remittance by age 22 was higher among males (p=0.008). Age at diagnosis was linearly associated with FEV1/FVC ratio at age 22. Late-onset (multinomial odds ratio [M-OR]= 7.4 [95% CI:3.9,14]) and persistent wheezing (M-OR=14.0 [6.8,28]) in early life, sensitization to Alternaria (M-OR=3.6 [2.1,6.4]), low airway function at age 6 (M-OR=2.1 [1.1,3.9]) and bronchial hyperresponsiveness at age 6 (M-OR=4.5 [1.9,10]) were independently associated with chronic asthma at age 22. Bronchial hyperresponsiveness (M-OR=6.9 [2.3,21]), low airway function at age 6 (M-OR=2.8 [1.1,6.9]), late-onset (M-OR=4.6 [1.7,12]) and persistent wheezing (M-OR=4.0 [1.2,14]) predicted newly diagnosed asthma at age 22. Among young adults, females preferentially develop newly diagnosed asthma, but most had already wheezed in early life and had bronchial hyperresponsiveness by age 6. The roots of early adult onset asthma can be found in the preschool years.