Håland Geir, Carlsen Karin C Lødrup, Sandvik Leiv, Devulapalli Chandra Sekhar, Munthe-Kaas Monica Cheng, Pettersen Morten, Carlsen Kai-Håkon
Department of Pediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo.
N Engl J Med. 2006 Oct 19;355(16):1682-9. doi: 10.1056/NEJMoa052885.
Reduced lung function in early infancy has been associated with later obstructive airway diseases. We assessed whether reduced lung function shortly after birth predicts asthma 10 years later.
We conducted a prospective birth cohort study of healthy infants in which we measured lung function shortly after birth with the use of tidal breathing flow-volume loops (the fraction of expiratory time to peak tidal expiratory flow to total expiratory time [t(PTEF)/t(E)]) in 802 infants and passive respiratory mechanics, including respiratory-system compliance, in 664 infants. At 10 years of age, 616 children (77%) were reassessed by measuring lung function, exercise-induced bronchoconstriction, and bronchial hyperresponsiveness (by means of a methacholine challenge) and by conducting a structured interview to determine whether there was a history of asthma or current asthma.
As compared with children whose t(PTEF)/t(E) shortly after birth was above the median, children whose t(PTEF)/t(E) was at or below the median were more likely at 10 years of age to have a history of asthma (24.3% vs. 16.2%, P=0.01), to have current asthma (14.6% vs. 7.5%, P=0.005), and to have severe bronchial hyperresponsiveness, defined as a methacholine dose of less than 1.0 micromol causing a 20% fall in the forced expiratory volume in 1 second (FEV1) (9.1% vs. 4.9%, P=0.05). As compared with children whose respiratory-system compliance was above the median, children with respiratory compliance at or below the median more often had a history of asthma (27.4% vs. 14.8%; P=0.001) and current asthma (15.0% vs. 7.7%, P=0.009), although this measure was not associated with later measurements of lung function. At 10 years of age, t(PTEF)/t(E) at birth correlated weakly with the maximal midexpiratory flow rate (r=0.10, P=0.01) but not with FEV1 or forced vital capacity.
Reduced lung function at birth is associated with an increased risk of asthma by 10 years of age.
婴儿早期肺功能降低与后期阻塞性气道疾病相关。我们评估了出生后不久肺功能降低是否能预测10年后的哮喘。
我们对健康婴儿进行了一项前瞻性出生队列研究，在802名婴儿中使用潮气呼吸流速容量环（呼气时间分数至潮气呼气峰值流速与总呼气时间之比[t(PTEF)/t(E)]）在出生后不久测量肺功能，并在664名婴儿中测量被动呼吸力学，包括呼吸系统顺应性。在10岁时，通过测量肺功能、运动诱发性支气管收缩和支气管高反应性（通过乙酰甲胆碱激发试验）以及进行结构化访谈以确定是否有哮喘病史或当前哮喘，对616名儿童（77%）进行了重新评估。
与出生后不久t(PTEF)/t(E)高于中位数的儿童相比，t(PTEF)/t(E)处于或低于中位数的儿童在10岁时更有可能有哮喘病史（24.3%对16.2%，P = 0.01）、当前患有哮喘（14.6%对7.5%，P = 0.005）以及有严重支气管高反应性，定义为乙酰甲胆碱剂量小于1.0微摩尔导致1秒用力呼气量（FEV1）下降20%（9.1%对4.9%，P = 0.05）。与呼吸系统顺应性高于中位数的儿童相比，呼吸系统顺应性处于或低于中位数的儿童更常有哮喘病史（27.4%对14.8%；P = 0.001）和当前哮喘（15.0%对7.7%，P = 0.009），尽管该指标与后期肺功能测量无关。在10岁时，出生时的t(PTEF)/t(E)与最大呼气中期流速弱相关（r = 0.10，P = 0.01），但与FEV1或用力肺活量无关。
出生时肺功能降低与10岁时哮喘风险增加相关。
