Reijonen T M, Kotaniemi-Syrjänen A, Korhonen K, Korppi M
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Pediatrics. 2000 Dec;106(6):1406-12. doi: 10.1542/peds.106.6.1406.
To evaluate the influence of early antiinflammatory therapy in the development of asthma 3 years after hospitalization for wheezing in infancy. In addition, the effects of allergic sensitization and respiratory syncytial virus (RSV) infection on the development of asthma were investigated.
A randomized, controlled follow-up study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.
Eighty-nine infants under 2 years of age who had been hospitalized for infection associated with wheezing and followed up for 3 years.
Early antiinflammatory therapy was given for 16 weeks; 29 patients received cromolyn sodium and 31 received budesonide. Twenty-nine control patients received no therapy.
Clinical diagnosis of current asthma, defined as having at least 3 episodes of physician-diagnosed wheezing and either a wheezing episode during the preceding year or ongoing antiinflammatory medication for asthma.
Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59-10.35), history of wheezing (RR 6.8; CI = 1.35-34.43), and atopic dermatitis on study entry (RR 3.4; CI = 1.17-9.39). Skin prick test positivity at the age of 16 months significantly predicted asthma (RR 9.5; CI = 2.45-36.72). In addition, all of the 18 (20%) children sensitized with furred pet developed asthma. RSV identification (RR 0.3; CI = 0.08-0.80) and early furred pet contact at home (RR 0.3; CI 0.10-0.79) were associated with the decreased occurrence of asthma.
Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict subsequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.
评估婴儿期因喘息住院后3年早期抗炎治疗对哮喘发生发展的影响。此外，还研究了过敏致敏和呼吸道合胞病毒（RSV）感染对哮喘发生发展的影响。
在一家为特定区域内所有儿科患者提供初级医院护理的大学医院进行的随机对照随访研究。
89名2岁以下因与喘息相关的感染住院并随访3年的婴儿。
早期抗炎治疗持续16周；29例患者接受色甘酸钠治疗，31例接受布地奈德治疗。29例对照患者未接受治疗。
当前哮喘的临床诊断，定义为至少有3次经医生诊断的喘息发作，且在前一年有喘息发作或正在使用哮喘抗炎药物。
前色甘酸钠组中有14例（48%）患者、前布地奈德组中有15例（48%）患者、对照组中有16例（55%）患者患有当前哮喘。哮喘的显著预测因素为年龄超过12个月（风险比[RR]4.1；95%置信区间[CI]=1.59 - 10.35）、喘息病史（RR 6.8；CI = 1.35 - 34.43）以及研究开始时的特应性皮炎（RR 3.4；CI = 1.17 - 9.39）。16个月大时皮肤点刺试验阳性显著预测哮喘（RR 9.5；CI = 2.45 - 36.72）。此外，所有18名（20%）对有毛宠物致敏的儿童均患哮喘。RSV检测阳性（RR 0.3；CI = 0.08 - 0.80）以及早期在家接触有毛宠物（RR 0.3；CI 0.10 - 0.79）与哮喘发生率降低相关。
婴儿期喘息后3年，4个月的抗炎治疗对哮喘的发生无影响。早期对室内过敏原尤其是宠物致敏以及特应性皮炎可预测随后哮喘的发生。喘息婴儿中的RSV感染可能比其他感染有更好的转归。
