Sears Malcolm R, Greene Justina M, Willan Andrew R, Wiecek Elizabeth M, Taylor D Robin, Flannery Erin M, Cowan Jan O, Herbison G Peter, Silva Phil A, Poulton Richie
Firestone Institute for Respiratory Health, Department of Medicine, McMaster University and St. Joseph's Healthcare, Hamilton, Ont., Canada.
N Engl J Med. 2003 Oct 9;349(15):1414-22. doi: 10.1056/NEJMoa022363.
The outcome of childhood asthma in adults has been described in high-risk cohorts, but few population-based studies have reported the risk factors for persistence and relapse.
We assessed children born from April 1972 through March 1973 in Dunedin, New Zealand, repeatedly from 9 to 26 years of age with questionnaires, pulmonary-function tests, bronchial-challenge testing, and allergy testing.
By the age of 26 years, 51.4 percent of 613 study members with complete respiratory data had reported wheezing at more than one assessment. Eighty-nine study members (14.5 percent) had wheezing that persisted from childhood to 26 years of age, whereas 168 (27.4 percent) had remission, but 76 (12.4 percent) subsequently relapsed by the age of 26. Sensitization to house dust mites predicted the persistence of wheezing (odds ratio, 2.41; P=0.001) and relapse (odds ratio, 2.18; P=0.01), as did airway hyperresponsiveness (odds ratio for persistence, 3.00; P<0.001; odds ratio for relapse, 3.03; P<0.001). Female sex predicted the persistence of wheezing (odds ratio, 1.71; P=0.03), as did smoking at the age of 21 years (odds ratio, 1.84; P=0.01). The earlier the age at onset, the greater the risk of relapse (odds ratio, 0.89 per year of increase in the age at onset; P<0.001). Pulmonary function was consistently lower in those with persistent wheezing than in those without persistent wheezing.
In an unselected birth cohort, more than one in four children had wheezing that persisted from childhood to adulthood or that relapsed after remission. The factors predicting persistence or relapse were sensitization to house dust mites, airway hyperresponsiveness, female sex, smoking, and early age at onset. These findings, together with persistently low lung function, suggest that outcomes in adult asthma may be determined primarily in early childhood.
在高危队列中已描述了成年期儿童哮喘的转归，但基于人群的研究很少报告哮喘持续存在和复发的危险因素。
我们对1972年4月至1973年3月在新西兰达尼丁出生的儿童，从9岁至26岁进行多次评估，采用问卷调查、肺功能测试、支气管激发试验和过敏测试。
到26岁时，613名有完整呼吸数据的研究对象中，51.4%报告在不止一次评估中有喘息。89名研究对象（14.5%）的喘息从儿童期持续到26岁，168名（27.4%）有缓解，但76名（12.4%）随后在26岁前复发。对屋尘螨过敏预示着喘息持续存在（比值比，2.41；P=0.001）和复发（比值比，2.18；P=0.01），气道高反应性也是如此（持续存在的比值比，3.00；P<0.001；复发的比值比，3.03；P<0.001）。女性预示着喘息持续存在（比值比，1.71；P=0.03）,21岁时吸烟也是如此（比值比，1.84；P=0.01）。发病年龄越早，复发风险越高（比值比，发病年龄每增加1岁为0.89；P<0.001）。持续喘息者的肺功能始终低于无持续喘息者。
在一个未经选择的出生队列中，超过四分之一的儿童有从儿童期持续到成年期的喘息或缓解后复发的喘息。预测持续存在或复发的因素是对屋尘螨过敏、气道高反应性、女性、吸烟和发病年龄早。这些发现，连同持续较低的肺功能，提示成人哮喘的转归可能主要在儿童早期就已确定。
