Dharmage Shyamali C, Perret Jennifer L, Custovic Adnan
Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Institute for Breathing and Sleep, Melbourne, VIC, Australia.
Front Pediatr. 2019 Jun 18;7:246. doi: 10.3389/fped.2019.00246. eCollection 2019.
Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.
哮喘是一种在全球范围内具有重要意义的非传染性疾病，对儿童和成人的公共卫生都有重大影响，包括高发病率以及严重病例中的死亡率。我们总结了有关哮喘趋势、环境决定因素和长期影响的证据，同时比较了儿童哮喘和成人哮喘的这些流行病学特征。虽然儿童哮喘的发病率和患病率较高，但成人的发病率和死亡率更高。儿童哮喘在男孩中更常见，而成人哮喘在女性中更常见，这种患病率性别差异的逆转发生在青春期左右，提示性激素可能在哮喘病因中起作用。在儿童和成人中均观察到的全球哮喘流行仍在持续，特别是在低收入和中等收入国家，尽管在一些发达国家已有所缓解。作为一种异质性疾病，需要充分表征不同的哮喘表型和内型，以便在研究和临床环境中制定更准确和有意义的定义。新的聚类技术如潜在类别分析可能有助于实现这一点，并且正在开发计算表型分析方法，以使用自然语言处理（NLP）算法从电子健康记录中检索信息，辅助哮喘的早期诊断。虽然一些引发哮喘的重要环境决定因素已得到充分证实，但仍需要更多工作来确定环境暴露在儿童和成人哮喘发展中的作用。越来越多的证据表明，对可能的基因-环境和环境-环境相互作用的研究可能有助于更好地揭示哮喘的决定因素。因此，迫切需要进一步研究环境和遗传决定因素之间的相互关系，以识别高危人群和关键的可改变暴露因素。对于儿童，哮喘可能损害气道发育并降低最大肺功能，并且这些肺功能缺陷可能持续到成年期而无额外的进行性丧失。成人哮喘可能加速肺功能下降并增加固定气流受限的风险，早发性哮喘的影响大于晚发性哮喘。因此，在管理哮喘时，我们未来的重点应坚定地不仅放在改善短期症状上
