Montella Silvia, Baraldi Eugenio, Cazzato Salvatore, Aralla Raffaele, Berardi Mariangela, Brunetti Luigia Maria, Cardinale Fabio, Cutrera Renato, de Benedictis Fernando Maria, di Palmo Emanuela, Di Pillo Sabrina, Fenu Grazia, La Grutta Stefania, Lombardi Enrico, Piacentini Giorgio, Santamaria Francesca, Ullmann Nicola, Rusconi Franca
Department of Translational Medical Sciences, Federico II University, Naples, Italy.
Women's and Children's Health Department, University of Padua, Padua, Italy.
Ital J Pediatr. 2016 Jan 22;42:9. doi: 10.1186/s13052-016-0217-z.
Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy.
We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6-17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients' characteristics and severe asthma or non-severe persistent asthma.
Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95 % Confidence Interval (CI), 1.21-18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95 % CI, 1.11-12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95 % CI, 2.70-53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95 % CI, 2.66-61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients' comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE .
As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation.
在欧洲，很少有研究探讨儿童重度哮喘的特征，且仅有一项研究是在南欧开展的。本研究的目的是详细描述在意大利各地专业儿科哮喘中心接受治疗的重度哮喘儿童的特征。
我们通过网络收集了41例年龄在6至17岁的重度哮喘患儿的家庭、环境、临床和实验室特征，这些患儿是根据欧洲呼吸学会和美国胸科学会的最新指南定义的，同时收集了78例年龄匹配的非重度持续性哮喘患儿的相关特征。这些患儿来自意大利北部、中部和南部的16家医院儿科肺病和过敏中心。逻辑回归分析评估了患者特征与重度哮喘或非重度持续性哮喘之间的关系。
与重度哮喘独立且显著相关的特征包括对食物过敏原的终生致敏（比值比[OR]，4.73；95%置信区间[CI]，1.21 - 18.53；p = 0.03）、因哮喘终生住院（OR，3.71；95% CI，1.11 - 12.33；p = 0.03）、过去一年因哮喘到急诊科就诊（OR = 11.98；95% CI，2.70 - 53.11；p = 0.001）以及由体力活动引发的症状（OR = 12.78；95% CI，2.66 - 61.40；p = 0.001）。重度哮喘患者的生活质量评分低于非重度持续性哮喘患者（5.9对6.6，p = 0.005）。两组中超过40%的患者的幸福感自我认知受到影响。重度哮喘儿童的肺功能仪z评分低于非重度哮喘儿童（所有p < 0.001），尽管其中56%的患儿一秒用力呼气量正常。两组在父母教育程度、家庭环境、患者合并症、治疗依从性、呼出一氧化氮值以及血清嗜酸性粒细胞和免疫球蛋白E方面未发现差异。
正如预期的那样，重度哮喘儿童的临床病程比非重度持续性哮喘儿童更严重，肺功能也更差。与之前的报告不同，我们发现重度哮喘患者与非重度持续性哮喘患者相比，对食物过敏原的致敏性更高，且环境和个人特征相似。在大量病例中，心理方面受到影响，值得进一步研究。
