Pediatric Pulmonology Unit, University Hospital, Federal University of Goiás, Primeira Avenida, S/N. Setor Leste Universitária, Goiânia, CEP: 746050-20, Brazil.
Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
BMC Pulm Med. 2018 Jul 3;18(1):109. doi: 10.1186/s12890-018-0669-6.
Multiple factors are involved in asthma exacerbations, including environmental exposure and viral infections. We aimed to assess the association between severe asthma exacerbations, acute respiratory viral infections and other potential risk factors.
Asthmatic children aged 4-14 years were enrolled for a period of 12 months and divided into two groups: those with exacerbated asthma (group 1) and non-exacerbated asthma (group 2). Clinical data were obtained and nasopharyngeal samples were collected through nasopharyngeal aspirate or swab and analysed via indirect fluorescent immunoassays to detect influenza A and B viruses, parainfluenza 1-3, adenovirus and respiratory syncytial virus. Rhinovirus was detected via molecular assays. Potential risk factors for asthma exacerbation were identified in univariate and multivariate analyses.
In 153 children (group 1: 92; group 2: 61), median age 7 and 8 years, respectively, the rate of virus detection was 87.7%. There was no difference between groups regarding the frequency of virus detection (p = 0.68); however, group 1 showed a lower frequency (19.2%) of inhaled corticosteroid use (91.4%, p < 0.01) and evidence of inadequate disease control. In the multivariate analysis, the occurrence of three or more visits to the emergency room in the past 12 months (IRR = 1.40; p = 0.04) and nonadherence to inhaled corticosteroid (IRR = 4.87; p < 0.01) were the only factors associated with exacerbation.
Our results suggest an association between asthma exacerbations, poor disease control and nonadherence to asthma medication, suggesting that viruses may not be the only culprits for asthma exacerbations in this population.
哮喘加重的原因包括环境暴露和病毒感染等多种因素。本研究旨在评估严重哮喘加重与急性呼吸道病毒感染及其他潜在危险因素之间的关系。
选择年龄在 4-14 岁之间的哮喘患儿，进行为期 12 个月的研究，分为哮喘加重组（第 1 组）和非哮喘加重组（第 2 组）。收集临床资料，通过鼻咽抽吸或拭子采集鼻咽样本，采用间接荧光免疫法检测流感 A 和 B 病毒、副流感病毒 1-3 型、腺病毒和呼吸道合胞病毒，采用分子检测法检测鼻病毒。采用单因素和多因素分析确定哮喘加重的潜在危险因素。
在 153 名儿童（第 1 组 92 名，第 2 组 61 名）中，年龄中位数分别为 7 岁和 8 岁，病毒检出率分别为 87.7%。两组病毒检出率无差异（p=0.68）；然而，第 1 组吸入皮质类固醇使用率（91.4%，p<0.01）和疾病控制不足的证据较低。多因素分析显示，过去 12 个月内就诊急诊 3 次以上（IRR=1.40，p=0.04）和未遵医嘱使用吸入皮质类固醇（IRR=4.87，p<0.01）是唯一与哮喘加重相关的因素。
我们的结果表明，哮喘加重与疾病控制不佳和哮喘药物治疗依从性差有关，这表明病毒可能不是该人群哮喘加重的唯一原因。
