Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Allergy Clin Immunol. 2012 Aug;130(2):403-7.e5. doi: 10.1016/j.jaci.2012.04.043. Epub 2012 Jul 4.
The diagnosis of asthma in young children is difficult and based on clinical assessment of symptoms and results of physical examination. Respiratory wheeze has traditionally been used to define asthma in young children.
We sought to compare the qualitative diagnosis of wheeze with a quantitative global assessment of significant troublesome lung symptoms during the first 3 years of life as a predictor of asthma by age 7 years.
Children born to asthmatic mothers (n= 411) were followed prospectively to age 7 years. Parents were instructed to visit the research clinic during the first 3 years of life each time the child had significant troublesome lung symptoms for 3 days. At the clinic, a research physician performed a physical examination, including auscultation for wheeze and excluding differential diagnoses. We tested whether wheeze was independently associated with asthma at age 7 years after adjusting for the total number of episodes.
Three hundred thirteen children had full follow-up by age 7 years. In a multivariable analysis the total number of acute clinic visits for asthma symptom was significantly associated with later asthma (P< .0001), whereas the presence of wheeze at these visits was not (P= .5). The total number of acute clinic visits for significant troublesome lung symptoms was also significantly associated with later asthma in children who had never presented with any wheeze (P= .03).
A quantitative global assessment of significant troublesome lung symptoms in the first 3 years of life is a better predictor of asthma than assessment of wheeze. Doctor-diagnosed wheeze is not a prerequisite for the diagnosis of asthma, and relying on the symptom of wheeze will likely be an important cause of undertreatment.
儿童哮喘的诊断较为困难，主要依据临床症状评估和体格检查结果。传统上，儿童哮喘的诊断依据是呼吸哮鸣。
我们旨在比较婴幼儿期哮鸣的定性诊断与定量评估 3 年内显著困扰性肺部症状的全球评估，以预测 7 岁时的哮喘。
对哮喘患儿的母亲所生的 411 名儿童进行前瞻性随访，直至 7 岁。父母被指导在孩子出现显著困扰性肺部症状持续 3 天的情况下，在 3 年内的每次就诊时带孩子去研究诊所。在研究诊所，研究医生进行体格检查，包括听诊哮鸣音并排除其他鉴别诊断。我们测试了在调整总发作次数后，哮鸣音是否与 7 岁时的哮喘独立相关。
313 名儿童在 7 岁时完成了完整随访。多变量分析显示，因哮喘就诊的急性发作次数与后续哮喘显著相关（P<.0001），而这些就诊时哮鸣音的存在与哮喘无显著相关性（P=.5）。在从未出现过任何哮鸣音的儿童中，因显著困扰性肺部症状就诊的急性发作次数也与后续哮喘显著相关（P=.03）。
3 年内显著困扰性肺部症状的定量全球评估是预测哮喘的更好指标，而不是评估哮鸣音。医生诊断的哮鸣音不是哮喘诊断的前提条件，仅依赖于哮鸣音症状可能是治疗不足的重要原因。
