Edwards Carole A, Osman Liesl M, Godden David J, Douglas J Graham
Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen, Scotland.
Chest. 2003 Jul;124(1):18-24. doi: 10.1378/chest.124.1.18.
Historically, clinicians have recognized the existence of the clinical syndrome of childhood wheezy bronchitis. In the late 1960s, children with this syndrome were relabeled as having asthma, and the term wheezy bronchitis was abandoned. In a 1989 study of a cohort that originally had been studied in 1964, we reported that those who had childhood wheezy bronchitis had as adults attained lung function similar to that of healthy control subjects and had less significant symptoms than did those who had experienced childhood asthma, in whom lung function was reduced. In this study, we reexamined these subjects 12 years later to determine whether the improved outcome of the wheezy bronchitis group had been maintained.
In 2001, we followed up the 283 participants of the 1989 study, who were now aged 45 to 50 years. In interviews, respiratory symptoms and smoking status were assessed. Spirometry was measured.
One hundred seventy-seven subjects (63%) completed the study. After adjusting for age, height, gender, socioeconomic status, smoking status, and number of pack-years smoked, the current FEV(1) in the childhood asthma group (mean, 2.45 L; 95% confidence interval, 2.29 to 2.62) was significantly lower than the wheezy bronchitis group (2.78 L, 95% confidence interval, 2.64 to 2.91; p < 0.01) and the control group (2.96 L; 95% confidence interval, 2.83 to 3.1; p < 0.01). The difference between the wheezy bronchitis group and the control subjects was not significant (p = 0.06). Between 1989 and 2001, both the childhood wheezy bronchitis group (p < 0.01) and the childhood asthma group (p = 0.01) had greater declines in FEV(1) than did the control group (asthma group decline, - 0.75 L [95% confidence interval, - 0.66 to - 0.84]; wheezy bronchitis group decline, - 0.75 L [95% confidence interval, - 0.68 to - 0.83]; control group decline, - 0.59 L [95% confidence interval, - 0.52 to - 0.67]). In 2001, the asthma group had more symptoms than did the wheezy bronchitis group (p < 0.01), who were more symptomatic than the control group (p < 0.01).
Those with childhood wheezy bronchitis, having achieved normal lung function in earlier adulthood, now show a more rapid decline in lung function than did control subjects. If this rate of decline persists, these subjects may develop obstructive airways disease in later life.
从历史上看，临床医生已认识到儿童喘息性支气管炎这一临床综合征的存在。20世纪60年代末，患有该综合征的儿童被重新归类为患有哮喘，“喘息性支气管炎”这一术语被弃用。在一项对1964年最初研究的队列进行的1989年研究中，我们报告称，那些患有儿童喘息性支气管炎的人成年后的肺功能与健康对照者相似，且症状比那些曾患儿童哮喘的人轻，后者的肺功能有所下降。在本研究中，我们在12年后重新检查了这些受试者，以确定喘息性支气管炎组的良好转归是否得以维持。
2001年，我们对1989年研究的283名参与者进行了随访，他们现在年龄在45至50岁之间。在访谈中，评估了呼吸症状和吸烟状况。进行了肺量计测量。
177名受试者（63%）完成了研究。在对年龄、身高、性别、社会经济地位、吸烟状况和吸烟包年数进行校正后，儿童哮喘组的当前第一秒用力呼气容积（FEV₁）（平均值为2.45升；95%置信区间为2.29至2.62）显著低于喘息性支气管炎组（2.78升，95%置信区间为2.64至2.91；p<0.01）和对照组（2.96升；95%置信区间为2.83至3.1；p<0.01）。喘息性支气管炎组与对照受试者之间的差异不显著（p = 0.06）。在1989年至2001年期间，儿童喘息性支气管炎组（p<0.01）和儿童哮喘组（p = 0.01）的FEV₁下降幅度均大于对照组（哮喘组下降-0.75升[95%置信区间为-0.66至-0.84]；喘息性支气管炎组下降-0.75升[95%置信区间为-0.68至-0.83]；对照组下降-0.59升[95%置信区间为-0.52至-0.67]）。2001年，哮喘组的症状比喘息性支气管炎组多（p<0.01），喘息性支气管炎组比对照组症状更多（p<0.01）。
那些患有儿童喘息性支气管炎的人在成年早期肺功能已恢复正常，但现在肺功能下降速度比对照受试者更快。如果这种下降速度持续下去，这些受试者在晚年可能会发展为阻塞性气道疾病。
