Antibiotics in Infancy-Risk Factor for Childhood Asthma

描述 （申请人提供）儿童哮喘的发病率和死亡率 在过去的三十年里，在所有发达国家， 包括在美国。 许多理论已经被提出， 解释哮喘的流行，但没有一个单一的理论可以仔细解释， 审查 最近的国际研究表明， 儿童哮喘风险增加与暴露于 抗生素在儿童时期，特别是在生命的第一年。 的 无论是否使用抗生素治疗， 呼吸道或非呼吸道感染。 虽然这些先前的研究 提示，每项研究都有重要的方法学问题。 一 大多数研究的主要问题是他们依赖于回顾性研究， 在暴露数年后，从父母那里召回抗生素暴露数据。 我们 有来自一项前瞻性的，NIH资助的研究的数据， 出生队列中早期环境暴露与哮喘的发生 的儿童随访至平均6.7岁。 6.7年时，482例（58%） 作为这项研究的一部分， 儿童哮喘研究（CAS）。 除了临床病史，6 - 7- 1年临床检查包括皮肤试验、IgE抗体试验、肺 功能测试和乙酰甲胆碱激发。 在进入所有的CAS儿童 健康联盟计划（Health Alliance Plan，HAP） 目前的建议是基于 将CAS数据集与从HAP数据中提取的药房数据相结合 档案 这将使我们能够研究可能的关系， 抗生素使用，根据处方确定，哮喘为6至7 岁的 虽然不是严格的前瞻性研究，但这些方法将 避免了以往研究中发现的许多潜在的偏倚来源。 我们 也将能够评估抗生素暴露与 和哮喘的其他危险因素，如卧室过敏原 水平，宠物所有权，香烟烟雾暴露，和父母的历史， 哮喘或过敏。 拟议的研究完全独立于 最初的拨款并不认为抗生素的使用是一种潜在的风险， 哮喘或过敏的因素。 这项新的分析将允许更多的 对早期使用抗生素与 和哮喘的发病率。

DESCRIPTION (Provided by Applicant) Morbidity and mortality from childhood asthma have been increasing in all developed countries over the past three decades, including in the United States. Numerous theories have been advanced to explain this asthma epidemic, but no single theory has held up to careful scrutiny. Recent international studies have suggested a relatively strong causal relationship between increased risk of childhood asthma and exposure to antibiotics during childhood, especially during the first year of life. The increased asthma risk was seen whether antibiotics were used to treat respiratory or non-respiratory infections. While these previous studies are suggestive, there are significant methodologic concerns about each study. A major concern with most of the studies is their reliance on retrospective recall of antibiotic exposure data from parents years after the exposure. We have data from a prospective, NIH-funded study of the relationship between early environmental exposures and the development of asthma in a birth cohort of children followed to an average 6.7 years of age. At 6.7 years, 482 (58%) of the original 833 children were clinically examined as part of this Childhood Asthma Study (CAS). In addition to clinical histories, the 6- to 7- year clinical examination included skin tests, IgE antibody tests, pulmonary function tests and methacholine challenge. At entry all of the CAS children were within the Health Alliance Plan (HAP) HMO. The current proposal is based on combining the CAS data set with pharmacy data extracted from the HAP data archives. This will allow us to examine possible relationships between antibiotic use, as determined by prescriptions filled, and asthma at 6 to 7 years of age. While not strictly a prospective study, these methods will avoid many of the potential sources of bias found in previous studies. We will also be able to evaluate any relationships between antibiotic exposure and asthma for confounding by other risk factors such as bedroom allergen levels, pet ownership, cigarette smoke exposure, and parental history of asthma or allergy. The proposed study is entirely separate from the goals of the original grant which did not consider antibiotic use as a potential risk factor for asthma or allergy. This new analysis will allow a much more rigorous examination of the possible relationship between early antibiotic use and asthma in a population of American children.