Hallas Henrik W, Chawes Bo L, Arianto Lambang, Rasmussen Morten A, Kunøe Asja, Stokholm Jakob, Bønnelykke Klaus, Bisgaard Hans
COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
J Allergy Clin Immunol Pract. 2020 Apr;8(4):1263-1271.e3. doi: 10.1016/j.jaip.2019.10.031. Epub 2019 Nov 9.
Children with asthma may have a disease course with or without exacerbations, but the relationship between exacerbations and lung function development is poorly understood.
To compare lung function trajectories from birth till adolescence in asthmatic children with and without exacerbations.
Children with asthma from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) birth cohort had lung function and bronchial reactivity assessed repeatedly from 1 month to 13 years. Exacerbations were diagnosed at the COPSAC clinic defined as symptoms requiring hospitalization, oral or high-dose inhaled corticosteroid treatment. Mixed models were applied to analyze lung function trajectories.
Children with asthma with exacerbations (N = 50) had a trajectory of increased, fixed airway obstruction compared with children without exacerbations (N = 47): z-score difference in airway resistance (sRaw) (95% confidence interval [CI]): +0.34 (+0.03; +0.66), P = .03, and maximal mid-expiratory flow (MMEF): -0.41 (-0.69; -0.13), P = .004, but no differences in forced expiratory volume (FEV): -0.14 (-0.41; +0.13), P = .29, or bronchial reactivity to methacholine (PD): +0.08 (-0.26; +0.42), P = .65. This did not change comparing lung function trajectories before and after exacerbations: z-score difference (95% CI) sRaw: -0.04 (-0.35; 0.27), P = .80; MMEF: 0.01 (-0.02; 0.04), P = .55; FEV: 0.02 (-0.02; 0.05), P = .42; and PD: -0.01 (-0.06; 0.05), P = .88.
Children with asthma with exacerbations compared with children with asthma without exacerbations are characterized by increased airway obstruction since infancy through childhood. The airway obstruction is a fixed trajectory without progression due to exacerbations, suggesting that exacerbations are a consequence rather than a cause of diminished airway caliber in childhood.
哮喘患儿的病程可能有或没有病情加重情况，但病情加重与肺功能发育之间的关系尚不清楚。
比较有和没有病情加重的哮喘患儿从出生到青春期的肺功能轨迹。
来自哥本哈根儿童哮喘前瞻性研究（COPSAC）出生队列的哮喘患儿从1个月至13岁期间多次接受肺功能和支气管反应性评估。病情加重在COPSAC诊所被诊断为需要住院治疗、口服或高剂量吸入糖皮质激素治疗的症状。应用混合模型分析肺功能轨迹。
与没有病情加重的患儿（N = 47）相比，有病情加重的哮喘患儿（N = 50）呈现气道阻塞增加且固定的轨迹：气道阻力（sRaw）的z评分差异（95%置信区间[CI]）：+0.34（+0.03；+0.66），P = 0.03，以及最大呼气中期流速（MMEF）：-0.41（-0.69；-0.13），P = 0.004，但在用力呼气容积（FEV）方面无差异：-0.14（-0.41；+0.13），P = 0.29，或对乙酰甲胆碱的支气管反应性（PD）方面也无差异：+0.08（-0.26；+0.42），P = 0.65。比较病情加重前后的肺功能轨迹时这一情况未改变：z评分差异（95%CI）sRaw：-0.04（-0.35；0.27），P = 0.80；MMEF：0.01（-0.02；0.04），P = 0.55；FEV：0.02（-0.02；0.05），P = 0.42；以及PD：-0.01（-0.06；0.05），P = 0.88。
与没有病情加重的哮喘患儿相比，有病情加重的哮喘患儿自婴儿期至儿童期的特征是气道阻塞增加。气道阻塞是一个固定轨迹，不会因病情加重而进展，这表明病情加重是儿童气道管径减小的结果而非原因。
