Matricardi P M, Illi S, Grüber C, Keil T, Nickel R, Wahn U, Lau S
Dept of Paediatric Pneumology and Immunology, Charité University Medical Centre, Augustenburger Platz 1, D-13353 Berlin, Germany.
Eur Respir J. 2008 Sep;32(3):585-92. doi: 10.1183/09031936.00066307. Epub 2008 May 14.
Childhood asthma is frequently perceived as a disease with uniform clinical pathways. This perception might be an oversimplification. The aim of the present study was to investigate the incidence and natural course of wheeze over the first 13 yrs of life and analyse the risk factors predicting wheeze at 11-13 yrs of age. The Multicentre Allergy Study, a German birth cohort, recruited 1,314 children in 1990. Physical examinations, interviews on atopic diseases, immunoglobulin (Ig)E and lung function tests were performed up to 13 yrs of age. Complete data on the course of wheeze were available for 441 children. It was found that incidence of wheezing declined with age. The first wheezing episode was reported by 29, 9 and 9% of participants at < or = 3 (early wheezers), 3-6 (late wheezers), and > 6 yrs (very late wheezers) of age, respectively. Wheezing at the age of 13 yrs was associated with parental atopy, and with IgE sensitisation to common allergens, elevated total IgE and exposure to high levels of indoor allergens in early life. All these associations were remarkably stronger among early wheezers than among early nonwheezers. In conclusion, the relevance of an early expression of atopy as a predictor of wheezing at age 13 yrs declines with increasing age of wheezing onset.
儿童哮喘常被视为具有统一临床路径的疾病。这种看法可能过于简单化。本研究的目的是调查13岁前喘息的发病率和自然病程，并分析预测11 - 13岁喘息的危险因素。多中心过敏研究是一项德国出生队列研究，1990年招募了1314名儿童。对这些儿童进行了直至13岁的体格检查、关于特应性疾病的访谈、免疫球蛋白（Ig）E检测和肺功能测试。441名儿童有关于喘息病程的完整数据。结果发现，喘息发病率随年龄下降。分别有29%、9%和9%的参与者在≤3岁（早期喘息者）、3 - 6岁（晚期喘息者）和>6岁（非常晚期喘息者）时首次报告喘息发作。13岁时的喘息与父母特应性、对常见过敏原的IgE致敏、总IgE升高以及早年接触高水平室内过敏原有关。所有这些关联在早期喘息者中比在早期非喘息者中明显更强。总之，特应性早期表现作为13岁时喘息预测指标的相关性随喘息发作年龄增加而下降。
