Nicolai T, Illi S, von Mutius E
Universitäts-Kinderklinik München, Germany.
Thorax. 1998 Dec;53(12):1035-40. doi: 10.1136/thx.53.12.1035.
Relatively little is known about risk factors for the persistence of asthma and respiratory symptoms from childhood into adolescence, and few studies have included objective measurements to assess outcomes and exposure.
From a large cross sectional study of all 4th grade school children in Munich (mean age 10.2 years), 234 children (5%) with active asthma were identified. Of these, 155 (66%) were reinvestigated with lung function measurements and bronchial provocation three years later (mean age 13.5 years).
At follow up 35.5% still had active asthma. Risk factors for persisting asthma symptoms in adolescence were more severe asthma (OR 4.94; CI 1.65 to 14.76; p = 0.004) or allergic triggers (OR 3.54; CI 1.41 to 8.92; p = 0.007) in childhood. Dampness was associated with increased night time wheeze and shortness of breath but not with persisting asthma. Risk factors for bronchial hyperreactivity in adolescence were bronchial hyperreactivity in childhood (p = 0.004), symptoms triggered by allergen exposure (OR 5.47; CI 1.91 to 25.20; p = 0.029), and damp housing conditions (OR 16.14; CI 3.53 to 73.73; p < 0.001). In a subgroup in whom house dust mite antigen levels in the bed were measured (70% of the sample), higher mite antigen levels were associated with bronchial hyperreactivity (OR per quartile of mite antigen 2.30; CI 1.03 to 5.12; p = 0.042). Mite antigen levels were also significantly correlated with dampness (p = 0.05). However, the effect of dampness on bronchial hyperreactivity remained significant when adjusting for mite allergen levels (OR 5.77; CI 1.17 to 28.44; p = 0.031).
Dampness at home is a significant risk factor for the persistence of bronchial hyperreactivity and respiratory symptoms in children with asthma. This risk is only partly explained by exposure to house dust mite antigen.
关于哮喘及呼吸道症状从儿童期持续至青春期的风险因素，人们了解相对较少，且很少有研究纳入客观测量来评估结局和暴露情况。
在对慕尼黑所有四年级学童进行的一项大型横断面研究中（平均年龄10.2岁），识别出234名（5%）患有活动性哮喘的儿童。其中，155名（66%）在三年后（平均年龄13.5岁）接受了肺功能测量和支气管激发试验的再次调查。
随访时，35.5%的儿童仍患有活动性哮喘。青春期持续哮喘症状的风险因素为儿童期哮喘更严重（比值比4.94；95%置信区间1.65至14.76；p = 0.004）或存在过敏触发因素（比值比3.54；95%置信区间1.41至8.92；p = 0.007）。潮湿与夜间喘息和呼吸急促增加有关，但与持续性哮喘无关。青春期支气管高反应性的风险因素为儿童期支气管高反应性（p = 0.004）、过敏原暴露引发的症状（比值比5.47；95%置信区间1.91至25.20；p = 0.029）以及潮湿的居住环境（比值比16.14；95%置信区间3.53至73.73；p < 0.001）。在一个对床上屋尘螨抗原水平进行测量的亚组中（样本的70%），较高的螨抗原水平与支气管高反应性相关（螨抗原每四分位数的比值比2.30；95%置信区间1.03至5.12；p = 0.042）。螨抗原水平也与潮湿显著相关（p = 0.05）。然而，在调整螨过敏原水平后，潮湿对支气管高反应性的影响仍然显著（比值比5.77；95%置信区间1.17至28.44；p = 0.031）。
家中潮湿是哮喘儿童支气管高反应性和呼吸道症状持续存在的一个重要风险因素。这种风险仅部分由接触屋尘螨抗原所解释。
