Kuehni C E, Davis A, Brooke A M, Silverman M
Department of Child Health, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
Lancet. 2001 Jun 9;357(9271):1821-5. doi: 10.1016/S0140-6736(00)04958-8.
Distinct wheezing disorders co-exist in young (preschool) children, some of which (early transient wheeze and viral wheeze) are thought to be unrelated to atopy. Investigation of changes in prevalence of wheezing disorders in preschool children could provide important clues about underlying mechanisms responsible for increasing prevalence of asthma in schoolchildren.
Repeated population surveys of the prevalence of respiratory symptoms were done by parent-completed postal questionnaires in random samples of 1650 (1990) and 2600 (1998) caucasian children aged 1-5 years living in the county of Leicestershire, UK.
The response rates were 86% (1422 of 1650) in 1990 and 84% (2127 of 2522) in 1998. Between 1990 and 1998, there was a significant increase in the prevalance of reported wheeze ever (16% to 29%, p<0.0001), current wheeze (12% to 26%, p<0.0001), diagnosis of asthma (11% to 19%, p<0.0001), treatment for wheeze (15% to 26%, p<0.0001), and admission for wheeze or other chest trouble (6% to 10%, p<0.0001). The increase occurred both in children with viral wheeze (9% to 19%) and in those with the classic asthma pattern of wheezing with multiple triggers (6% to 10%). There was also an increase in transient early wheezers (3% to 5%), persistent wheezers (5% to 13%), and late-onset wheezers (6% to 8%), and in all severity groups. The increase could not be accounted for by putative household risk factors because these declined between the 2 years.
The fact that all preschool wheezing disorders increased (including viral wheeze) makes it probable that factors unrelated to atopy are implicated in the changing epidemiology of wheeze in childhood.
不同类型的喘息性疾病在幼儿（学龄前儿童）中并存，其中一些（早期一过性喘息和病毒性喘息）被认为与特应性无关。调查学龄前儿童喘息性疾病患病率的变化，可为学龄儿童哮喘患病率上升的潜在机制提供重要线索。
通过家长填写邮寄问卷，对居住在英国莱斯特郡的1650名（1990年）和2600名（1998年）1 - 5岁白人儿童随机样本进行反复的呼吸道症状患病率调查。
1990年的应答率为86%（1650名中的1422名），1998年为84%（2522名中的2127名）。1990年至1998年期间，曾有喘息的报告患病率（16%至29%，p<0.0001）、当前喘息患病率（12%至26%，p<0.0001）、哮喘诊断率（11%至19%，p<0.0001）、喘息治疗率（15%至26%，p<0.0001）以及因喘息或其他胸部问题住院率（6%至10%，p<0.0001）均显著上升。病毒性喘息儿童（9%至19%）和具有多种触发因素的典型哮喘性喘息儿童（6%至10%）的患病率均有所上升。早期一过性喘息者（3%至5%）、持续性喘息者（5%至13%）和迟发性喘息者（6%至8%）以及所有严重程度组的患病率也有所上升。这种上升不能用假定的家庭危险因素来解释，因为这些因素在这两年间有所下降。
所有学龄前喘息性疾病（包括病毒性喘息）均增加这一事实表明，与特应性无关的因素可能与儿童喘息流行病学的变化有关。
