Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Eur Respir J. 2017 Nov 2;50(5). doi: 10.1183/13993003.00014-2017. Print 2017 Nov.
The distinction between episodic viral wheeze (EVW) and multitrigger wheeze (MTW) is used to guide management of preschool wheeze. It has been questioned whether these phenotypes are stable over time. We examined the temporal stability of MTW and EVW in two large population-based cohorts.We classified children from the Avon Longitudinal Study of Parents and Children (n=10 970) and the Leicester Respiratory Cohorts ((LRCs), n=3263) into EVW, MTW and no wheeze at ages 2, 4 and 6 years based on parent-reported symptoms. Using multinomial regression, we estimated relative risk ratios for EVW and MTW at follow-up (no wheeze as reference category) with and without adjusting for wheeze severity.Although large proportions of children with EVW and MTW became asymptomatic, those that continued to wheeze showed a tendency to remain in the same phenotype: among children with MTW at 4 years in the LRCs, the adjusted relative risk ratio was 15.6 (95% CI 8.3-29.2) for MTW (stable phenotype) compared to 7.0 (95% CI 2.6-18.9) for EVW (phenotype switching) at 6 years. The tendency to persist was weaker for EVW and from 2-4 years. Results were similar across cohorts.This suggests that MTW, and to a lesser extent EVW, tend to persist regardless of wheeze severity.
间歇性病毒性喘息（EVW）和多触发喘息（MTW）的区别用于指导学龄前喘息的管理。有人质疑这些表型是否随时间稳定。我们在两个大型基于人群的队列中检查了 MTW 和 EVW 的时间稳定性。我们根据父母报告的症状，将雅芳纵向父母和儿童研究（n=10970）和莱斯特呼吸队列（LRCs，n=3263）中的儿童分为 EVW、MTW 和无喘息，年龄为 2、4 和 6 岁。使用多项回归，我们估计了随访时 EVW 和 MTW 的相对风险比（无喘息为参考类别），并调整了喘息严重程度。尽管很大比例的 EVW 和 MTW 患儿无症状，但继续喘息的患儿有倾向于保持相同的表型：在 LRCs 中，4 岁时患有 MTW 的儿童中，调整后的相对风险比为 15.6（95%CI 8.3-29.2），而 6 岁时为 EVW（表型转换）的为 7.0（95%CI 2.6-18.9）。EVW 的持续性倾向较弱，从 2 岁到 4 岁。两个队列的结果相似。这表明，MTW，并且在较小程度上 EVW，无论喘息严重程度如何，都有持续存在的趋势。
