Mallol Javier, Solé Dirceu, Garcia-Marcos Luis, Rosario Nelson, Aguirre Viviana, Chong Herberto, Urrutia-Pereira Marilyn, Szulman Gabriela, Niederbacher Jurg, Arruda-Chavez Erika, Toledo Eliana, Sánchez Lillian, Pinchak Catalina
Department of Pediatric Respiratory Medicine, Hospital El Pino, University of Santiago de Chile (USACH), Santiago, Chile.
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Allergy Asthma Immunol Res. 2016 Jan;8(1):22-31. doi: 10.4168/aair.2016.8.1.22. Epub 2015 Jul 27.
This study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants.
In this international, cross-sectional, and community-based study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life.
The prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively).
RW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.
本研究旨在确定拉丁美洲婴儿出生后第一年复发性喘息（RW，定义为喘息发作≥3次）的患病率、严重程度、危险因素以及所开具的治疗方法。
在这项国际性、横断面且基于社区的研究中，来自南美洲6个国家（阿根廷、巴西、智利、哥伦比亚、秘鲁和乌拉圭）11个中心的12405名婴儿的父母完成了一份关于喘息及相关风险/保护因素、哮喘药物、出生后第一年抗生素和对乙酰氨基酚的处方频率及指征的问卷。
RW的患病率为16.6%（95%置信区间16.0 - 17.3）；在12405名婴儿中，72.7%（95%置信区间70.7 - 74.6）因喘息前往急诊科就诊，29.7%（27.7 - 31.7）住院。关于治疗，49.1%的RW婴儿接受吸入性糖皮质激素治疗，55.7%接受口服糖皮质激素治疗，26.3%接受白三烯调节剂治疗，22.9%的婴儿使用抗生素≥4次，主要用于普通感冒、喘息和咽炎，57.5%的婴儿使用对乙酰氨基酚≥4次。孕期吸烟、家庭月收入<1000美元、父母有哮喘病史、男性以及上幼儿园是RW患病率和严重程度较高的显著危险因素，而母乳喂养至少3个月是显著的保护因素。与整个样本相比，RW婴儿的肺炎及因肺炎住院率显著更高（分别为3.5倍和3.7倍）。
RW在婴儿出生后第一年影响十分之一点六的婴儿，严重发作患病率高，频繁前往急诊科就诊，且因喘息频繁住院。除哮喘药物处方量增加外，RW婴儿以及整个样本中抗生素和对乙酰氨基酚的使用也过量，这主要与普通感冒有关。
