Blackman James A, Gurka Matthew J
Department of Pediatrics, Division of Developmental Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.
J Dev Behav Pediatr. 2007 Apr;28(2):92-9. doi: 10.1097/01.DBP.0000267557.80834.e5.
Asthma is the most common chronic childhood illness. Treatment is typically focused on disease management rather than developmental and behavioral comorbidities that may affect quality of life or contribute to poor disease control. The purpose of this study was to explore the prevalence of developmental and behavioral comorbidities of asthma and the role of confounding socioeconomic factors.
The first National Survey of Children's Health was the data source for this study. Interviews with parents or guardians were conducted during 2003-2004 to ascertain the physical, emotional, and behavioral health of 102,353 randomly selected children ages 0-17 years. Associations were examined between asthma and rates of developmental and behavioral problems. Logistic regression was used to adjust for potential confounding effects of age, gender, race, income, and parent education on outcomes.
Children with asthma have higher rates of attention-deficit/hyperactivity disorder; diagnoses of depression, behavioral disorders, learning disabilities; and missed school days (all p < .0001). The more severe the asthma is, the higher the rates are of these problems. Children with asthma are bullied more commonly and are more likely to abuse drugs. When socioeconomic factors are controlled for, asthma significantly increases the odds of having developmental, emotional, and behavioral problems.
Children with asthma, especially severe asthma, are at high risk of developmental, emotional, and behavioral problems. Asthma is independently associated with these problems, although socioeconomic disadvantage adds additional risk. Asthma treatment programs must acknowledge and address these comorbidities to achieve the best overall outcomes for children with this common chronic disease.
哮喘是儿童最常见的慢性疾病。治疗通常侧重于疾病管理，而非可能影响生活质量或导致疾病控制不佳的发育和行为共病。本研究的目的是探讨哮喘发育和行为共病的患病率以及混杂社会经济因素的作用。
本研究的数据来源为首次全国儿童健康调查。在2003 - 2004年期间对父母或监护人进行访谈，以确定102353名随机抽取的0至17岁儿童的身体、情感和行为健康状况。研究哮喘与发育和行为问题发生率之间的关联。采用逻辑回归分析来调整年龄、性别、种族、收入和父母教育程度对结果的潜在混杂影响。
哮喘患儿患注意力缺陷/多动障碍、抑郁症、行为障碍、学习障碍的比例更高，且缺课天数更多（所有p < 0.0001）。哮喘病情越严重，这些问题的发生率越高。哮喘患儿更常受到欺负，且更有可能滥用药物。在控制社会经济因素后，哮喘显著增加了出现发育、情感和行为问题的几率。
哮喘患儿，尤其是重度哮喘患儿，面临发育、情感和行为问题的高风险。哮喘与这些问题独立相关，尽管社会经济劣势会增加额外风险。哮喘治疗项目必须认识并解决这些共病问题，以实现患有这种常见慢性病儿童的最佳总体治疗效果。
