Rhinitis in children and adolescents with asthma: Ubiquitous, difficult to control, and associated with asthma outcomes.
Rhinitis in children and adolescents with asthma: Ubiquitous, difficult to control, and associated with asthma outcomes.
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DOI：
10.1016/j.jaci.2018.07.041
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Busse WW
中科院分区：
文献类型：
--
作者：
Togias A;Gergen PJ;Hu JW;Babineau DC;Wood RA;Cohen RT;Makhija MM;Khurana Hershey GK;Kercsmar CM;Gruchalla RS;Liu AH;Wang E;Kim H;Lamm CI;Bacharier LB;Pillai D;Sigelman SM;Gern JE;Busse WW
鼻炎和哮喘是有联系的，但在这种关系中存在大量的知识空白。确定哮喘儿童和青少年中鼻炎的患病率及其表型，评估症状严重程度和控制鼻炎的药物需求，并调查鼻炎和哮喘之间的相关性。749名哮喘儿童参与了Inner-City研究中的哮喘表型，接受了基线评估，并接受了为期1年的基于算法的鼻炎和哮喘治疗。鼻炎的诊断问卷调查集中在个人的症状，并通过结合皮肤测试和血清特异性IgE的症状模式，确定预定义的表型。对619名哮喘儿童进行了分析，这些儿童至少完成了6次访视中的4次。93.5%的患者存在鼻炎，基线时确定的表型在观察/管理年得到证实。常年性变应性鼻炎伴季节性加重（PARSE）是最常见的（34.2%）和严重的。非过敏性鼻炎最不常见（11.3%），严重程度最轻。尽管使用鼻用皮质类固醇±口服抗组胺药，但大多数儿童仍有症状。难控哮喘患者的鼻炎比易控哮喘患者更严重，其季节性模式与难控哮喘患者部分一致。鼻炎在城市哮喘儿童中几乎无处不在，其活动性与下呼吸道疾病密切相关。PARSE是最严重的表型，最可能与难以控制的哮喘相关。这项研究为鼻炎和哮喘代表一种疾病在气道两个部分的表现的概念提供了强有力的支持。几乎所有的儿童和青少年哮喘患者都有各种稳定的鼻炎表型，这些表型基于致敏性和季节性模式。传统药物控制鼻炎症状只有在少数。难以控制的哮喘与更严重的鼻炎有关。
Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. 749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by questionnaire focusing on individual symptoms, and pre-defined phenotypes were determined by combining symptom patterns with skin testing and serum specific IgE. Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was most common (34.2%) and severe. Nonallergic rhinitis was least common (11.3%) and least severe. The majority of children remained symptomatic despite the use of nasal corticosteroids ± oral antihistamines. Rhinitis was worse in difficult-to-control vs. easy-to-control asthma and its seasonal patterns partially corresponded to those of difficult-to-control asthma. Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. PARSE is the most severe phenotype and most likely to be associated with difficult-to-control asthma. This study offers strong support to the concept that rhinitis and asthma represent the manifestations of one disease in two parts of the airways. Almost all children and adolescents with asthma have rhinitis of various, stable phenotypes based on sensitization and seasonal pattern. Conventional medications control rhinitis symptoms only in a minority. Difficult-to- control asthma is associated with worse rhinitis.
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发表时间：
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期刊：
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影响因子：
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