Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol. 2019 May;143(5):1752-1759.e6. doi: 10.1016/j.jaci.2018.09.038. Epub 2018 Nov 14.
Few data exist on the predictors of asthma remission by early adulthood in North America.
The predictors of adult asthma remission were determined in a multiethnic population of patients with mild-to-moderate persistent childhood asthma.
Asthma remission in early adulthood was measured by using 2 definitions: a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures by using multivariate logistic regression. The probability of remission was modeled by using decision tree analysis.
In 879 subjects the mean ± SD baseline age was 8.8 ± 2.1 years, 59.4% were male, and 68.7% were white. By adulthood, 229 (26.0%) of 879 participants were in clinical remission, and 111 (15.0%) of 741 participants were in strict remission. The degree of FEV/forced vital capacity (FVC) ratio impairment was the largest predictor of asthma remission. More than half of boys and two thirds of girls with baseline FEV/FVC ratios of 90% or greater were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission odds ratio, 1.23 [95% CI, 1.09-1.39]; strict remission odds ratio, 1.52 [95% CI, 1.26-1.84]). The combination of normal FEV/FVC ratio, airways responsiveness, and serum eosinophil count at baseline yielded greater than 80% probability of remission by adulthood.
A considerable minority of patients with persistent childhood asthma will have disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.
在北美，关于成年早期哮喘缓解的预测因素的数据很少。
在一个多民族人群中，确定轻度至中度持续性儿童期哮喘患者成年后哮喘缓解的预测因素。
通过使用两种定义来衡量成年早期的哮喘缓解：临床定义和严格定义。这两种定义都包括正常的肺功能以及无症状、无恶化和无药物使用。严格定义还包括正常的气道反应性。通过使用多变量逻辑回归从 23 个基线测量中确定预测因素。通过决策树分析来预测缓解的可能性。
在 879 名受试者中，平均基线年龄为 8.8 ± 2.1 岁，59.4%为男性，68.7%为白人。成年后，879 名参与者中有 229 名（26.0%）处于临床缓解，741 名参与者中有 111 名（15.0%）处于严格缓解。FEV/用力肺活量（FVC）比值损害程度是哮喘缓解的最大预测因素。基线 FEV/FVC 比值为 90%或更高的男孩中有一半以上，女孩中有三分之二在成年后处于缓解状态。气道反应性降低也是两种缓解定义的预测因素（临床缓解比值比，1.23 [95%CI，1.09-1.39]；严格缓解比值比，1.52 [95%CI，1.26-1.84]）。基线时正常的 FEV/FVC 比值、气道反应性和血清嗜酸性粒细胞计数的组合可使成年后缓解的可能性大于 80%。
相当一部分持续性儿童哮喘患者在成年后会出现疾病缓解。哮喘缓解的临床预后指标，包括基线肺功能，从早期就可以看到。
