Skylogianni E, Triga M, Douros K, Bolis K, Priftis K N, Fouzas S, Anthracopoulos M B
Pediatric Pulmonology and Allergy Unit, Department of Pediatrics, University of Patras Medical School, Patras, Greece.
3rd Department of Pediatrics, "Attikon" Hospital, University of Athens School of Medicine, Athens, Greece.
Allergol Immunopathol (Madr). 2018 Jul-Aug;46(4):313-321. doi: 10.1016/j.aller.2017.09.025. Epub 2018 Jan 12.
Epidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the existence of SAD in non-asthmatic children with AR and to assessed its ability to predict the development of asthma.
Seventy-three 6-year-old children with intermittent moderate-severe AR but without asthma symptoms/medication within the last two years, underwent spirometry and measurement of respiratory resistance (Rrs) and reactance (Xrs) before and after bronchodilation (BD) (300mcg salbutamol). Lung function measurements were performed in the absence of nasal symptoms and repeated at AR exacerbation. SAD was defined as >30% decrease in Rrs or >50% increase in Xrs at 6 or 8Hz post-BD. Participants were followed for five years.
Twenty-three children (31.5%) developed asthma; this group presented significant post-BD changes in Rrs and Xrs, but only at AR exacerbation. The ability of these changes to predict the development of asthma was exceptional and superior to that of the spirometric parameters. SAD (22 children, 30.1%), emerged as the single most efficient predictor of asthma, independently of other risk factors such as parental asthma, personal history of eczema and type of allergic sensitisation.
SAD precedes the development of asthma in children with AR. Changes in respiratory impedance at AR exacerbation may assist in identifying those at risk to progress to asthma.
流行病学证据表明变应性鼻炎（AR）与哮喘之间存在直接联系。多项研究也支持患有AR的非哮喘儿童存在小气道功能障碍（SAD）。然而，SAD是否能预测AR进展为哮喘仍不清楚。我们的目的是探讨患有AR的非哮喘儿童中SAD的存在情况，并评估其预测哮喘发生的能力。
73名6岁间歇性中重度AR儿童，在过去两年内无哮喘症状/未使用哮喘药物，在支气管扩张（BD）（300μg沙丁胺醇）前后进行肺活量测定以及呼吸阻力（Rrs）和电抗（Xrs）测量。在无鼻部症状时进行肺功能测量，并在AR加重时重复测量。SAD定义为BD后6或8Hz时Rrs下降>30%或Xrs增加>50%。对参与者进行了5年的随访。
23名儿童（31.5%）发展为哮喘；该组在BD后Rrs和Xrs有显著变化，但仅在AR加重时出现。这些变化预测哮喘发生的能力非常突出，且优于肺活量测定参数。SAD（22名儿童，30.1%）成为哮喘的唯一最有效预测指标，独立于其他风险因素，如父母哮喘、个人湿疹病史和变应性致敏类型。
SAD先于患有AR的儿童发生哮喘。AR加重时呼吸阻抗的变化可能有助于识别那些有进展为哮喘风险的儿童。
