Children's Hospital of Orange County(CHOC), Orange, CA, USA.
J Pediatr. 2011 Jun;158(6):953-959.e1. doi: 10.1016/j.jpeds.2010.11.029. Epub 2011 Jan 13.
To determine the relationship of poor asthma control to bronchodilator response (BDR) phenotypes in children with normal spirometry.
Children with asthma were assessed for clinical indexes of poorly controlled asthma. Pre- and post-bronchodilator spirometry were performed, and the percent BDR was determined. Multivariate logistic regression assessed the relationship of the clinical indices to BDR at ≥ 8%, ≥ 10%, and ≥ 12% BDR thresholds.
There were 510 controller naïve children and 169 on controller medication. In the controller naïve population the mean age (± 1 SD) was 9.5 (3.4); 57.1% were male, 85.7% Hispanic. Demographics were similar in both populations. In the adjusted profile, significant clinical relationships were found particularly to positive BDR phenotypes ≥ 10% and ≥ 12% versus negative responses including younger age, (OR 2.0, 2.5; P < .05), atopy (OR 1.9, 2.6; P < .01), nocturnal symptoms in females (OR 3.4, 3.8; P < .01); β₂ agonist use (OR 1.7, 2.8; P < .01); and exercise limitation (OR 2.2, 2.5; P < .01) only in the controller naïve population.
The BDR phenotype ≥ 10% is significantly related to poor asthma control, providing a potentially useful objective tool in controller naïve children even when the pre-bronchodilator spirometry result is normal.
确定正常肺功能儿童中哮喘控制不佳与支气管扩张剂反应(BDR)表型的关系。
评估哮喘儿童的临床指标,以评估哮喘控制不佳的情况。进行支气管扩张剂前和支气管扩张剂后肺量测定,并确定 BDR 的百分比。多元逻辑回归评估临床指标与 BDR≥8%、BDR≥10%和 BDR≥12%的关系。
共有 510 名未使用控制器的儿童和 169 名使用控制器的儿童。在未使用控制器的人群中,平均年龄(±1SD)为 9.5(3.4);57.1%为男性,85.7%为西班牙裔。两个人群的人口统计学特征相似。在调整后的模型中,发现了与阳性 BDR 表型(BDR≥10%和 BDR≥12%)显著相关的临床关系,与阴性反应相比,包括年龄较小(OR 2.0,2.5;P<.05)、过敏(OR 1.9,2.6;P<.01)、女性夜间症状(OR 3.4,3.8;P<.01)、β₂激动剂使用(OR 1.7,2.8;P<.01);和运动受限(OR 2.2,2.5;P<.01),仅在未使用控制器的人群中存在。
BDR 表型≥10%与哮喘控制不佳显著相关,即使在支气管扩张剂前肺量测定结果正常的情况下,也为未使用控制器的儿童提供了一种潜在有用的客观工具。