Division of Pediatric Pulmonology, Department of Pediatrics, Miller School of Medicine, University of Miami, 1580 North West 10th Avenue, Miami, FL 33136, USA.
Curr Opin Pulm Med. 2012 Jan;18(1):63-9. doi: 10.1097/MCP.0b013e32834db288.
This review critically assesses recently published literature on predicting asthma exacerbations in children, while also providing general recommendations for future research in this field.
Current evidence suggests that every effort should be made to provide optimal treatment to achieve adequate asthma control, as this will significantly reduce the risk of severe disease exacerbations. Children who have had at least one asthma exacerbation in the previous year are at highest risk for subsequent exacerbations, regardless of disease severity and/or control. Although several tools and biomarkers to predict asthma exacerbations have been recently developed, these approaches need further validation and/or have only had partial success in identifying children at risk.
Although considerable progress has been made, much remains to be done. Future studies should clearly differentiate severe asthma exacerbations due to inadequate asthma control from those occurring in children whose asthma is well controlled, utilize standardized definitions of asthma exacerbations, and use a systematic approach to identify the best predictors after accounting for the multiple dimensions of the problem. Our ability to correctly predict the development of severe asthma exacerbations in an individual child should improve in parallel with increased knowledge and/or understanding of the complex interactions among genetic, environmental (e.g. viral infections) and lifestyle (e.g. adherence to treatment) factors underlying these events.
本文批判性地评估了近期发表的关于预测儿童哮喘发作的文献，并为该领域的未来研究提供了一般性建议。
目前的证据表明，应尽一切努力提供最佳治疗以实现充分的哮喘控制，因为这将显著降低严重疾病恶化的风险。过去一年中至少有一次哮喘发作的儿童，无论疾病严重程度和/或控制程度如何，发生随后哮喘发作的风险最高。尽管最近已经开发出了几种预测哮喘发作的工具和生物标志物，但这些方法需要进一步验证，或者仅在识别有风险的儿童方面取得了部分成功。
尽管已经取得了相当大的进展，但仍有许多工作要做。未来的研究应该清楚地区分由于哮喘控制不佳导致的严重哮喘发作和那些在哮喘控制良好的儿童中发生的哮喘发作，使用哮喘发作的标准化定义，并在考虑到问题的多个维度后，采用系统的方法来识别最佳预测因子。随着对遗传、环境（例如病毒感染）和生活方式（例如治疗依从性）因素之间复杂相互作用的了解和/或理解的增加，我们正确预测个体儿童严重哮喘发作发展的能力应该会提高。
