Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Pediatr Allergy Immunol. 2011 Feb;22(1 Pt 1):9-18. doi: 10.1111/j.1399-3038.2010.01098.x. Epub 2010 Sep 30.
Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p=0.003), came from families with a lower socioeconomic status (p=0.01), were less physically active (p=0.04), and had more comorbidity with rhinoconjunctivitis (p=0.01) than did the 39 children with CA. The former also exhibited lower FEV(1) values (p=0.02) and increased bronchial hyper-responsiveness (p=0.01), but there were no differences in atopy (p=0.81) or FE(NO) (p=0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma.
患有问题严重哮喘（PA）的儿童，要么由于存在加重因素而难以治疗，要么对治疗严重抵抗。我们调查了一组患有 PA 的学龄儿童，并将这些儿童与年龄匹配的持续性哮喘（CA）控制良好的儿童进行了比较。目的是描述患有 PA 的儿童的特征，并确定对治疗严重抵抗的儿童。在这项对不同表现持续性哮喘的儿童进行的横断面、多中心比较中，PA 根据 GINA 定义为尽管接受了 4 级治疗，但哮喘控制仍不足。该方案包括问卷调查、肺量测定、乙酰甲胆碱激发试验、呼出气一氧化氮分数（FE(NO)）和鼻气流测量、炎症生物标志物和过敏检测的血液采样，以及鼻窦和肺部的计算机断层扫描（仅在 PA 组中进行）。在 54 名患有 PA 的儿童中，61%患有治疗抵抗性哮喘，其余的由于确定的加重因素而难以治疗。与 39 名患有 CA 的儿童相比，患有 PA 的儿童的父母更常有哮喘（p=0.003），来自社会经济地位较低的家庭（p=0.01），身体活动较少（p=0.04），并更常伴有过敏性鼻炎-结膜炎（p=0.01）。前者还表现出较低的 FEV(1)值（p=0.02）和增加的支气管高反应性（p=0.01），但在过敏（p=0.81）或 FE(NO)（p=0.16）方面没有差异。一项涉及标准化和详细临床特征描述的非侵入性方案，揭示了 PA 儿童的区别特征，并能够识别出对治疗抵抗的哮喘儿童。
