Pathways through which asthma risk factors contribute to asthma severity in inner-city children.
Pathways through which asthma risk factors contribute to asthma severity in inner-city children.
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哮喘危险因素导致内城区儿童哮喘严重程度的途径。
DOI：
10.1016/j.jaci.2016.06.060
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Busse WW
中科院分区：
文献类型：
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作者：
Liu AH;Babineau DC;Krouse RZ;Zoratti EM;Pongracic JA;O'Connor GT;Wood RA;Khurana Hershey GK;Kercsmar CM;Gruchalla RS;Kattan M;Teach SJ;Makhija M;Pillai D;Lamm CI;Gern JE;Sigelman SM;Gergen PJ;Togias A;Visness CM;Busse WW
通路分析可用于确定宿主和环境因素如何影响哮喘的严重程度。调查解释市中心儿童哮喘严重程度的途径。基于已发表文献中的医学证据，我们开发了一个概念模型来描述8个风险因素领域（过敏原致敏、过敏性炎症、肺生理学、压力、肥胖、维生素D、环境烟草烟雾（ETS）暴露和鼻炎严重程度）与哮喘严重程度的关系。为了估计这些领域与哮喘严重程度之间的假设关系的相对大小和意义，我们应用因果网络分析来测试我们的模型在内城哮喘协会的研究。参与者包括来自美国9个市中心的6-17岁哮喘和鼻炎儿童（n=561），他们每两个月接受一次评估，持续一年。通过对白天和夜间症状、急性发作和控制器使用的纵向复合评估来测量哮喘严重程度。我们的概念模型解释了哮喘严重程度的53.4%的方差。过敏途径（将过敏原致敏、过敏性炎症、肺生理学和鼻炎严重程度领域与哮喘严重程度联系起来）和ETS暴露途径（将ETS暴露和肺生理学领域与哮喘严重程度联系起来）对哮喘严重程度产生显著影响。在这些领域中，肺生理学和鼻炎严重程度对哮喘严重程度的标准化总影响最大（分别为-0.51和0.48），其次是ETS暴露（0.30）和过敏性炎症（0.22）。虽然维生素D对哮喘严重程度有适度但显著的间接影响，但其总影响不显著（0.01）。因果网络分析产生的标准化效应量量化了不同领域的相对贡献，并可用于确定干预措施的优先顺序，以解决哮喘严重程度。
Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. Investigate pathways explaining asthma severity in inner-city children. Based on medical evidence in the published literature, we developed a conceptual model to describe how eight risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke (ETS) exposure and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6–17 year old children (n=561) with asthma and rhinitis from 9 U.S. inner-cities who were evaluated every two months for one year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, and controller usage. Our conceptual model explained 53.4% of the variance in asthma severity. An allergy pathway (linking allergen sensitization, allergic inflammation, pulmonary physiology, and rhinitis severity domains to asthma severity) and ETS exposure pathway (linking ETS exposure and pulmonary physiology domains to asthma severity) exerted significant effects on asthma severity. Among the domains, pulmonary physiology and rhinitis severity had the largest significant standardized total effects on asthma severity (−0.51 and 0.48 respectively), followed by ETS exposure (0.30) and allergic inflammation (0.22). While vitamin D had modest but significant indirect effects on asthma severity, its total effect was insignificant (0.01). The standardized effect sizes generated by a causal network analysis quantify the relative contributions of different domains and can be used to prioritize interventions to address asthma severity.