Jones Marcus H, Roncada Cristian, Fernandes Morgana Thais Carollo, Heinzmann-Filho João Paulo, Sarria Icaza Edgar Enrique, Mattiello Rita, Pitrez Paulo Marcio C, Pinto Leonardo A, Stein Renato T
Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
School of Nursing, Centro Universitário Ritter dos Reis, Porto Alegre, Brazil.
Front Pediatr. 2017 Dec 18;5:270. doi: 10.3389/fped.2017.00270. eCollection 2017.
An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children.
We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol.
188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 scores, < 0.001) and higher FEV (+0.79 scores, = 0.004) and lower FEV/FVC (-0.54 scores, = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 scores, = 0.005) and lower FEV/FVC (-0.50 scores, = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 scores in FVC and FEV, respectively, and a reduction in FEV/FVC by 0.40 scores ( < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 scores, = 0.012) and FEV (0.35 scores, = 0.034) but not with FEV/FVC and FEF. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator.
Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.
超重和哮喘的患病率呈上升趋势。这两种情况均对成人和儿童的肺功能产生负面影响。本研究旨在分析超重和哮喘对儿童肺功能的影响。
我们设计了一项病例对照研究，该研究嵌套于一项针对8至16岁儿童的哮喘流行病学患病率研究中，研究对象为健康和哮喘患儿。通过强迫振荡法和肺活量测定法评估哮喘和超重对肺功能的影响，这些测定在基线时以及使用沙丁胺醇后10 - 15分钟进行。
共招募了188名儿童，其中114名（61%）为哮喘患儿，72名（38%）超重或肥胖。与健康对照组相比，患有哮喘和超重的儿童的用力肺活量（FVC）更高（+1.16分，P < 0.001），第一秒用力呼气容积（FEV）更高（+0.79分，P = 0.004），而FEV/FVC更低（-0.54分，P = 0.008）。与正常体重的哮喘患儿相比，超重患儿的FVC更高（+0.78分，P = 0.005），FEV/FVC更低（-0.50分，P = 0.007）。在多变量分析中，超重分别与FVC增加0.71分和FEV增加0.44分相关，且FEV/FVC降低0.40分（所有P < 0.01）。超重对基线时的最大流量和气道阻力无影响，且吸入支气管扩张剂后也未改变这一情况。哮喘也与支气管扩张剂使用后FVC升高（0.45分，P = 0.012）和FEV升高（0.35分，P = 0.034）相关，但与FEV/FVC和用力呼气流量（FEF）无关。双向方差分析未发现哮喘和超重之间在支气管扩张剂使用前后对肺功能变量存在任何相互作用。
我们的结果表明，哮喘和超重与儿童气道发育异常独立相关，可使用强迫振荡法进一步仔细研究。在不增加气道阻力的情况下，超重对儿童FEV/FVC降低的影响比哮喘更大。在超重患病率高的人群中，肺活量测定法对阻塞性疾病的特异性和敏感性可能会降低。在肺活量测定法中加入阻抗振荡法可提高我们对超重儿童通气异常的理解。
