Bacharier Leonard B, Dawson Christopher, Bloomberg Gordon R, Bender Bruce, Wilson Laura, Strunk Robert C
Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri 63110, USA.
Pediatrics. 2003 Aug;112(2):e85-92. doi: 10.1542/peds.112.2.e85.
Asthma in childhood has a significant impact on children and families, in part because of the frequent need for hospital-based care for acute exacerbations. Sensitization and exposure to inhalant allergens have been identified as risk factors for asthma hospitalization.
The Childhood Asthma Management Program (CAMP), comprised of 1041 children aged 5 to 12 with mild-to-moderate asthma, provides the opportunity to identify specific risk factors for prior hospitalization for asthma.
Data gathered during the screening period from CAMP were evaluated to elucidate differences between patients who had ever been hospitalized for asthma before enrollment in CAMP and those who had never been hospitalized.
Univariate analyses indicated that prior hospitalization for asthma was associated with a younger age of asthma onset, longer duration of asthma, greater number of positive allergy skin tests, higher serum immunoglobulin E level, greater peripheral blood eosinophilia, greater recent inhaled corticosteroid use, greater airflow obstruction, greater airway hyperresponsiveness, and lower patient intelligence quotient (IQ). Gender, race, and family income did not differ between hospitalized and never-hospitalized patients. The combination of both sensitization and exposure to high levels of dog allergen (Can f1) was associated with greater likelihood of prior hospitalization. Forward multivariate logistic regression analysis identified younger age of asthma onset, longer duration of asthma, recent use of asthma controller therapy, greater airflow obstruction, and lower patient IQ as significant risk factors for prior hospitalization when all risk factors identified by univariate analysis were included in the model.
Children with mild-to-moderate asthma who had a past hospitalization for acute asthma had greater asthma severity, younger age of onset, and lower patient IQ at the time of entry into CAMP. They also had more markers of atopy than children without prior hospitalization, although atopy was not associated with prior hospitalization on multivariate analysis. Although we have identified these risk factors in a retrospective manner, one can speculate that the persistence of these features should alert the clinician to closely follow abnormalities on pulmonary function tests and general features of atopy to potentially identify patients at risk for future hospitalization.
儿童哮喘对儿童及其家庭有重大影响，部分原因是急性加重时经常需要住院治疗。已确定吸入性过敏原致敏和暴露是哮喘住院的危险因素。
儿童哮喘管理项目（CAMP）由1041名5至12岁的轻至中度哮喘儿童组成，提供了识别哮喘既往住院的特定危险因素的机会。
对在CAMP筛查期间收集的数据进行评估，以阐明在CAMP入组前曾因哮喘住院的患者与从未住院的患者之间的差异。
单因素分析表明，哮喘既往住院与哮喘发病年龄较小、哮喘病程较长、阳性过敏皮肤试验数量较多、血清免疫球蛋白E水平较高、外周血嗜酸性粒细胞增多、近期吸入糖皮质激素使用较多、气流阻塞较重、气道高反应性较高以及患者智商较低有关。住院患者和未住院患者在性别、种族和家庭收入方面没有差异。致敏和暴露于高水平狗过敏原（Can f1）两者的组合与既往住院的可能性较大有关。向前多因素逻辑回归分析确定，当单因素分析确定的所有危险因素纳入模型时，哮喘发病年龄较小、哮喘病程较长、近期使用哮喘控制治疗、气流阻塞较重以及患者智商较低是既往住院的显著危险因素。
因急性哮喘既往住院的轻至中度哮喘儿童在进入CAMP时哮喘严重程度更高、发病年龄更小且患者智商更低。与无既往住院的儿童相比，他们也有更多的特应性标志物，尽管在多因素分析中特应性与既往住院无关。尽管我们是以回顾性方式确定这些危险因素的，但可以推测这些特征的持续存在应提醒临床医生密切关注肺功能检查异常和特应性的一般特征，以潜在识别未来有住院风险的患者。
