National Jewish Health, Denver, CO 80206, USA.
J Allergy Clin Immunol. 2010 Feb;125(2):359-366.e3. doi: 10.1016/j.jaci.2009.10.037.
The course of mild to moderate persistent asthma in children is not clearly established.
To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence.
The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent).
Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV(1) PC(20) (OR, 1.39; P = .03), higher prebronchodilator FEV(1) percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04).
Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.
儿童轻度至中度持续性哮喘的病程尚不清楚。
确定青少年缓解、周期性和持续性哮喘的发生率和预测因素。
儿童哮喘管理计划（CAMP）是一项为期 4.3 年的随机、双盲、多中心试验，纳入了轻度至中度持续性哮喘患儿，比较了布地奈德或奈多罗米治疗组与安慰剂组的持续性治疗，随后进行了 4 年的观察随访。观察期间的哮喘活动包括缓解（过去 1 年内无哮喘活动）、持续（每季度均有哮喘活动）和周期性哮喘（既未缓解也未持续）。
909 名参与者中，哮喘缓解率为 6%，周期性哮喘为 39%，持续性哮喘为 55%，在 CAMP 试验中早期使用抗炎治疗并未发现效果。在所有 3 种哮喘活动类别中，气道高反应性、嗜酸性粒细胞增多症和哮喘发病率均随时间改善。与持续性哮喘相比，CAMP 试验进入时的特征与缓解相关的特征为无过敏原致敏和室内过敏原暴露（比值比[OR]，3.23；P<0.001）、哮喘较轻（OR，2.01；P=0.03）、年龄较大（OR，1.23；P=0.01）、气道高反应性较低（较高的对数乙酰甲胆碱 FEV1 PC20（OR，1.39；P=0.03）、较高的预支气管扩张 FEV1 占预计值百分比（OR，1.05；P=0.02）和较低的用力肺活量占预计值百分比（OR，0.96；P=0.04）。
青少年哮喘缓解并不常见，4 年抗炎控制治疗对其并无影响。致敏和暴露、低肺功能和气道高反应性等因素降低了缓解哮喘的可能性。
