Panettieri Reynold A, Covar Ronina, Grant Evalyn, Hillyer Elizabeth V, Bacharier Leonard
Pulmonary, Allergy & Critical Care Division, University of Pennsylvania, Philadelphia, PA 19104-3403, USA.
J Allergy Clin Immunol. 2008 Mar;121(3):607-13. doi: 10.1016/j.jaci.2008.01.006.
Environmental exposures during the early years and airway obstruction that develops during this time, in conjunction with genetic susceptibility, are important factors in the development of persistent asthma in childhood. Established risk factors for childhood asthma include frequent wheezing during the first 3 years, a parental history of asthma, a history of eczema, allergic rhinitis, wheezing apart from colds, and peripheral blood eosinophilia, as well as allergic sensitization to aeroallergens and certain foods. Risk factors for the development of asthma in adulthood remain ill defined. Moreover, reasons for variability in the clinical course of asthma--persistence in some individuals and progression in others--remain an enigma. The distinction between disease persistence and disease progression suggests that these are different entities or phenotypes. There is currently no consensus on whether disease progression requires either airway inflammation or airway remodeling or the combination of the two. For patients with irreversible airway obstruction, inflammation might, in part, be necessary but perhaps not entirely sufficient to induce the irreversible component, some of which could be attributed to alterations in the structure of the bronchial wall. Intervening with intermittent or daily inhaled corticosteroids in high-risk infants and children does not prevent disease progression or impaired lung growth. These findings, however, might not apply to adults, and further study in adults is needed to determine the effect of inhaled corticosteroid therapy on disease progression.
早年的环境暴露以及在此期间出现的气道阻塞，再加上遗传易感性，是儿童期持续性哮喘发生发展的重要因素。儿童哮喘已确定的危险因素包括头3年频繁喘息、父母有哮喘病史、湿疹病史、过敏性鼻炎、非感冒引起的喘息、外周血嗜酸性粒细胞增多，以及对气传变应原和某些食物的过敏致敏。成人哮喘发生发展的危险因素仍不明确。此外，哮喘临床病程变异的原因——一些个体病情持续，另一些个体病情进展——仍然是个谜。疾病持续和疾病进展的区别表明这是不同的实体或表型。目前对于疾病进展是否需要气道炎症或气道重塑或两者兼而有之尚无共识。对于患有不可逆气道阻塞的患者，炎症可能部分是必要的，但可能不足以完全诱发不可逆成分，其中一些可能归因于支气管壁结构的改变。对高危婴幼儿使用间歇性或每日吸入糖皮质激素并不能预防疾病进展或肺生长受损。然而，这些发现可能不适用于成人，需要对成人进行进一步研究以确定吸入糖皮质激素治疗对疾病进展的影响。
