Department of Allergy, Helsinki University Central Hospital, P O Box 160, FI-00029 Helsinki, Finland.
Thorax. 2011 Feb;66(2):157-62. doi: 10.1136/thx.2010.139246. Epub 2011 Jan 2.
Relationships between early deficits of lung function, infant airway pathology and outcome in symptomatic infants are unclear. A study was undertaken to determine the associations between early lung function, airway histology and inflammation in symptomatic infants with the continuance of respiratory symptoms, lung function and subsequent use of inhaled asthma medication at the age of 3 years.
53 children who underwent lung function measurements and bronchoscopy following referral to a specialist children's hospital for recurrent lower respiratory symptoms at a mean age of 1 year were followed up at 3 years of age. Assessments were made of respiratory symptoms during the previous year, lung function by oscillometry and atopy by skin prick testing. Individual data on the purchase of asthma medications were obtained from the Social Insurance Institution for the 12 months preceding the follow-up visit.
50 children (94%) were re-evaluated, of whom 40 had ongoing airway symptoms. 11/39 (28%) who underwent successful oscillometry had reduced lung function, 31/50 (62%) used inhaled corticosteroids (ICS) regularly and 12/50 (24%) used ICS intermittently. Abnormal lung function at infancy was associated with ongoing airway symptoms (p<0.001) and with the purchase of ICS (p=0.009) and β agonists (p=0.002). Reticular basement membrane thickness in infancy and the numbers of mucosal mast cells, but not eosinophils, correlated significantly with the amount of ICS purchased at 3 years (p=0.003 and p=0.018, respectively).
Reduced lung function, thickening of the reticular basement membrane and increased density of mucosal mast cells in infancy are associated with respiratory morbidity and treatment needs at age 3 years in this highly selected group of children.
早期肺功能缺陷、婴儿气道病理学与有症状婴儿结局之间的关系尚不清楚。本研究旨在确定有症状婴儿早期肺功能、气道组织学和炎症与持续呼吸道症状、3 岁时肺功能以及随后使用吸入性哮喘药物之间的相关性。
53 名因反复下呼吸道症状而在 1 岁时转诊至专科医院的患儿接受了肺功能测量和支气管镜检查，在 3 岁时进行了随访。评估了前一年的呼吸道症状、呼吸振荡法测量的肺功能和皮肤点刺试验检测的特应性。通过社会医疗保险机构，获得了在随访前 12 个月购买哮喘药物的个人数据。
50 名儿童（94%）接受了重新评估，其中 40 名仍存在气道症状。39 名成功接受呼吸振荡法测量肺功能的儿童中，有 11 名（28%）肺功能下降，50 名儿童中有 31 名（62%）常规使用吸入性皮质类固醇（ICS），12 名（24%）间歇性使用 ICS。婴儿期肺功能异常与持续气道症状（p<0.001）和 ICS（p=0.009）和β激动剂（p=0.002）的使用相关。婴儿期网状基底膜厚度和黏膜肥大细胞数量与 3 岁时 ICS 的使用量呈显著相关（p=0.003 和 p=0.018），但与嗜酸性粒细胞数量无相关性。
在这组高度选择的患儿中，婴儿期肺功能下降、网状基底膜增厚和黏膜肥大细胞密度增加与 3 岁时的呼吸道发病率和治疗需求相关。
