Hyvärinen Mari K, Kotaniemi-Syrjänen Anne, Reijonen Tiina M, Korhonen Kaj, Korppi Matti O
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Pediatr Pulmonol. 2005 Oct;40(4):316-23. doi: 10.1002/ppul.20273.
The role of factors related to early wheezing and their associations with subsequent development of asthma are controversial. We reevaluated 81 children who had been prospectively followed up since hospitalization for wheezing at less than 2 years of age. The baseline data on characteristics of the children, family-related factors, and viral causes of wheezing were collected on entry into the study. At the median age of 12.3 years, current symptoms suggestive of asthma and allergy were recorded. As part of the clinical examination, an outdoor exercise challenge test and skin prick tests to common inhalant allergens were performed. Asthma, as indicated by current inhaled anti-inflammatory medication or repeated wheezing and positive result in the challenge test, was present in 32 (40%) children, and 90% of them were sensitized to at least one allergen. Early asthma-predictive factors were atopic dermatitis (odds ratio (OR), 3.5; 95% confidence interval (CI), 1.2-10.1) and the presence of specific IgE to inhalant allergens (OR, 11.3; 95% CI, 1.9-67.6). Respiratory syncytial virus (RSV) identification during wheezing in infancy was relatively rare (20%) among later asthmatics compared with other or no viral identification (52%) or rhinovirus identification (58%). Since the prevalence of childhood asthma in our area is 4.0-5.0%, we conclude that the increased risk of asthma persists until the teenage years after hospitalization for wheezing in infancy. The risk was about 5-fold after respiratory syncytial virus-induced wheezing, and more than 10-fold after rhinovirus-induced wheezing in the present study.
与早期喘息相关的因素及其与哮喘后续发展的关联存在争议。我们重新评估了81名自2岁以下因喘息住院后接受前瞻性随访的儿童。在进入研究时收集了有关儿童特征、家庭相关因素和喘息病毒病因的基线数据。在12.3岁的中位年龄时，记录了当前提示哮喘和过敏的症状。作为临床检查的一部分，进行了户外运动激发试验和针对常见吸入性过敏原的皮肤点刺试验。根据目前吸入性抗炎药物治疗或反复喘息以及激发试验阳性判断存在哮喘的儿童有32名（40%），其中90%对至少一种过敏原敏感。早期哮喘预测因素为特应性皮炎（优势比（OR），3.5；95%置信区间（CI），1.2 - 10.1）和存在针对吸入性过敏原的特异性IgE（OR，11.3；95%CI，1.9 - 67.6）。与其他病毒未检出（52%）或鼻病毒检出（58%）相比，在后来患哮喘的儿童中，婴儿期喘息时呼吸道合胞病毒（RSV）检出相对较少（20%）。由于我们地区儿童哮喘患病率为4.0 - 5.0%，我们得出结论，婴儿期因喘息住院后，哮喘风险增加一直持续到青少年时期。在本研究中，呼吸道合胞病毒诱发喘息后风险约为5倍，鼻病毒诱发喘息后风险超过10倍。
