De Marco Roberto, Locatelli Francesca, Cerveri Isa, Bugiani Massimiliano, Marinoni Alessandra, Giammanco Giuseppe
Unit of Epidemiology and Medical Statistics, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy.
J Allergy Clin Immunol. 2002 Aug;110(2):228-35. doi: 10.1067/mai.2002.125600.
The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings.
This study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18,873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000.
The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis.
The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men, P <.001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years, P <.001) and a shorter duration of the disease (5.6 vs 16.1 years, P <.001) than patients with current asthma. The probability of remission was strongly (P <.001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and > or =20-years age-at-onset groups, respectively).
With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population.
了解哮喘从出生到成年的自然病史可为其病因及流行病学研究结果的理解提供重要线索。
本研究旨在利用1998年至2000年在意大利进行的一项大型全国代表性横断面研究中18873名受试者的数据，评估从出生到44岁哮喘的发病率和缓解率。
哮喘发作定义为首次发作的年龄，当受试者既未接受治疗且在过去24个月内也未经历哮喘发作时，则认为处于缓解期。采用人年和生存技术进行分析。
1953年至2000年期间的年均发病率为每年2.56/1000人。发病率在10岁以下男孩（每年4.38/1000人）和30岁及以上女性（每年3.1/1000人）中达到峰值，并呈现代际上升趋势（1974 - 1979年出生队列与1953 - 1958年出生队列相比，发病率比 = 2.63，95%CI = 2.20 - 3.12）。总体缓解率为45.8%（女性为41.6%，男性为49.5%，P < .001）。缓解期的哮喘患者发病年龄较早（7.8岁对15.9岁，P < .001），疾病持续时间较短（5.6年对16.1年，P < .001），与当前哮喘患者相比。缓解的概率与发病年龄呈强烈负相关（发病年龄<10岁和≥20岁组分别为62.8%和15.0%，P < .001）。
就其自然病史而言，哮喘呈现两种不同形式：早发型哮喘，在儿童早期发病，主要影响男孩，预后良好；晚发型哮喘，通常在青春期期间或之后发病，主要影响女性，预后不良。早发型哮喘中未缓解的少数患者占普通年轻成年人群中当前哮喘患者的35%以上。
