Abreo Andrew, Gebretsadik Tebeb, Stone Cosby A, Hartert Tina V
Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Clin Transl Med. 2018 Jun 11;7(1):15. doi: 10.1186/s40169-018-0195-4.
Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.
儿童哮喘在美国导致了严重的发病率和医疗保健支出。哮喘发病率在幼儿期最高，并且在缺乏预防和干预措施的情况下，预计患病率将持续上升。预防哮喘可能需要多方面的干预策略；然而，很少有随机对照试验评估过此类方法。本综述的目的是利用先前的荟萃分析来确定哮喘发展最具影响力的风险因素，并评估降低风险因素对未来儿童哮喘患病率的影响。影响较大的常见且可改变的风险因素包括急性病毒性呼吸道感染、抗生素使用、剖宫产、营养失调（超重、肥胖）、二手烟暴露、过敏原致敏、母乳喂养以及充足的产前维生素D水平。对高危人群风险因素改变的评估和估计应引导科学家和政策制定者关注适合进一步研究和干预的高影响领域。
