The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Thorax. 2018 Feb;73(2):167-173. doi: 10.1136/thoraxjnl-2017-210149. Epub 2017 Nov 3.
Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent.
We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children.
This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years.
Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV, FVC, FEV:FVC and forced expiratory flow at 75% of FVC (FEF) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns.
Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
生命早期的呼吸道感染可能会影响气道阻塞，并增加日后患哮喘的风险。然而，之前的研究结果并不一致。
我们研究了生命早期的呼吸道感染与学龄儿童的肺功能和哮喘之间的关系。
这项在 2002 年 4 月至 2006 年 1 月期间出生的 5197 名儿童中进行的研究，嵌入了一项基于人群的前瞻性队列研究。通过每年的问卷调查，获取了 6 岁前（分为≤3 岁和>3-6 岁）因上、下呼吸道感染而就医的信息。在 10 岁时进行了肺功能测量和医生诊断的哮喘评估。
上呼吸道感染与不良呼吸结局无关。与没有下呼吸道感染≤3 岁的儿童相比，下呼吸道感染≤3 岁的儿童的 FEV、FVC、FEV/FVC 和 75%用力肺活量时的呼气流速（FEF）较低（Z 评分（95%CI）：范围为-0.22（-0.31 至-0.12）至-0.12（-0.21 至-0.03）），且哮喘的风险增加（比值比（95%CI）：1.79（1.19 至 2.59））。仅在下呼吸道感染>3-6 岁的儿童中，哮喘的风险增加（3.53（2.37 至 5.17））。结果不受抗生素或对乙酰氨基酚使用的影响，也不受吸入性过敏致敏的影响。交叉滞后模型表明，结果不是双向的，与学龄前喘息模式无关。
生命早期的下呼吸道感染≤3 岁与学龄儿童的肺功能下降和哮喘风险增加最密切相关。
