Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK.
Thorax. 2018 Sep;73(9):813-824. doi: 10.1136/thoraxjnl-2017-210939. Epub 2018 Jun 5.
Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care.
We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop.
From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk.
Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives.
CRD42016037464.
哮喘发作会导致相当大的发病率，甚至可能致命。我们旨在确定和权衡儿童（5-12 岁）哮喘发作的风险因素，以便为护理提供信息和确定重点。
我们系统地检索了六个数据库（2016 年 5 月；2017 年 1 月更新时包含了向前引用），没有语言/日期限制。两位评审员独立选择纳入研究，评估研究质量并提取数据。由于存在异质性，因此无法进行荟萃分析。通过专家小组进行加权，他们独立评估每个变量的风险程度和评估的置信度（基于研究质量和大小、效应大小、生物学合理性和结果的一致性），然后通过讨论达成共识。最后在多学科研讨会上展示、讨论和商定评估结果。
从 16109 条记录中，我们纳入了 68 篇论文（28 项队列研究；4 项病例对照研究；36 项横断面研究）。先前的哮喘发作与发作的风险大大增加相关（OR 值在 2.0 到 4.1 之间）。持续存在的症状（OR 值在 1.4 到 7.8 之间）和获得医疗保健机会差（OR 值在 1.2 到 2.3 之间）与中度/高度增加的风险相关。药物方案不理想、合并特应性/过敏性疾病、非裔美国人种族（美国）、贫困和维生素 D 缺乏与中度增加的风险相关。环境烟草烟雾暴露、年龄较小、肥胖和父母教育程度低与轻度增加的风险相关。
评估本综述中确定的临床和人口统计学特征，可能有助于临床医生将降低风险的管理重点放在高危儿童身上。人口水平的因素可被卫生服务规划者和政策制定者用于确定医疗保健计划的重点。
CRD42016037464。
