Lukkarinen Minna, Koistinen Annamari, Turunen Riitta, Lehtinen Pasi, Vuorinen Tytti, Jartti Tuomas
Department of Paediatrics, University of Turku and Turku University Hospital, Turku, Finland.
Department of Paediatrics, University of Turku and Turku University Hospital, Turku, Finland.
J Allergy Clin Immunol. 2017 Oct;140(4):988-995. doi: 10.1016/j.jaci.2016.12.991. Epub 2017 Mar 25.
Persistent childhood asthma is mainly atopy driven. However, limited data exist on the risk factors for childhood asthma phenotypes.
We sought to identify risk factors at the first severe wheezing episode for current asthma 7 years later and separately for atopic and nonatopic asthma.
One hundred twenty-seven steroid-naive children with the first severe wheezing episode (90% hospitalized/10% emergency department treated) were followed for 7 years. The primary outcome was current asthma at age 8 years, which was also analyzed separately as atopic and nonatopic asthma. Risk factors, including sensitization, viral cause, and other main asthma risk factors, were analyzed.
At study entry, median age was 11 months (interquartile range, 6-16 months); 17% were sensitized, and 98% were virus positive. Current asthma (n = 37) at 8 years was divided into atopic (n = 19) and nonatopic (n = 18) asthma. The risk factors for current atopic asthma at study entry were sensitization (adjusted odds ratio [OR], 12; P < .001), eczema (adjusted OR, 4.8; P = .014), and wheezing with rhinovirus (adjusted OR, 5.0; P = .035). The risk factors for nonatopic asthma were the first severe respiratory syncytial virus/rhinovirus-negative wheezing episode (adjusted OR, 8.0; P = .001), first wheezing episode at age less than 12 months (adjusted OR, 7.3; P = .007), and parental smoking (adjusted OR, 3.8; P = .028).
The data suggest diverse asthma phenotypes and mechanisms that can be predicted by using simple clinical markers at the time of the first severe wheezing episode. These findings are important for designing early intervention strategies for secondary prevention of asthma.
儿童期持续性哮喘主要由特应性驱动。然而，关于儿童哮喘表型的危险因素的数据有限。
我们试图确定首次严重喘息发作时的危险因素，以预测7年后的当前哮喘情况，并分别针对特应性和非特应性哮喘进行预测。
对127名首次出现严重喘息发作（90%住院治疗/10%在急诊科治疗）且未使用过类固醇的儿童进行了7年的随访。主要结局是8岁时的当前哮喘情况，同时也分别分析了特应性哮喘和非特应性哮喘。分析了包括致敏、病毒病因及其他主要哮喘危险因素在内的危险因素。
研究开始时，中位年龄为11个月（四分位间距，6 - 16个月）；17%的儿童致敏，98%的儿童病毒检测呈阳性。8岁时的当前哮喘（n = 37）分为特应性哮喘（n = 19）和非特应性哮喘（n = 18）。研究开始时当前特应性哮喘的危险因素为致敏（调整后的优势比[OR]，12；P <.001）、湿疹（调整后的OR，4.8；P =.014）以及与鼻病毒相关的喘息（调整后的OR，5.0；P =.035）。非特应性哮喘的危险因素为首次严重呼吸道合胞病毒/鼻病毒阴性的喘息发作（调整后的OR，8.）。
