To Masako, Tsuzuki Ryuta, Katsube Otohiro, Yamawaki Satoshi, Soeda Seiko, Kono Yuta, Honda Natsue, Kano Ichino, Haruki Kosuke, To Yasuo
Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Sumida, Tokyo, Japan; Department of Laboratory Medicine, Dokkyo Medical University, Saitama Medical Center, Koshigaya City, Saitama, Japan.
Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Sumida, Tokyo, Japan.
J Allergy Clin Immunol Pract. 2020 Jun;8(6):1921-1927.e2. doi: 10.1016/j.jaip.2020.01.011. Epub 2020 Jan 22.
In approximately 30% of children with asthma, the condition persists into adulthood. The longer duration of asthma in these patients is a risk factor for poor asthma control. However, the characteristics of adult patients with asthma that has persisted since childhood are not well documented.
We sought to compare the clinical characteristics among patients with adult-onset asthma, patients who outgrew childhood asthma but relapsed, and patients with persistent asthma since childhood.
We conducted a cross-sectional study of adult patients with asthma who visited our hospital. We classified them into 3 groups: those with adult-onset asthma (adult-onset), those who had remitted childhood asthma that relapsed (relapsed), and those who had asthma that had persisted since childhood (persistent). The clinical characteristics of these groups were compared.
A total of 1443 patients were enrolled. The persistent group was younger and included fewer patients with a smoking history. There were statistically significant differences among the 3 groups in the percentages of patients with a family history of asthma and comorbidities of allergic rhinitis and atopic dermatitis. The proportion of patients with severe asthma differed among the 3 groups (31% in the adult-onset group, 34% in the relapsed group, and 40% in the persistent group; P = .015). The values of forced expiratory flow at 75% of vital capacity were lower in the persistent group than the relapsed or adult-onset group. A multivariable logistic regression analysis (dependent variable: severe asthma) in each group revealed that the factors associated with severe asthma differed among the adult-onset, relapsed, and persistent groups. When we established an overall model that included interaction terms of cohort-by-other factors, there was a trend that comorbidity of allergic rhinitis affected the severity of asthma differently in the relapsed group compared with the other groups.
The clinical phenotype of asthma that persists from childhood to adulthood seems to be a distinct phenotype of adult asthma.
在大约30%的哮喘儿童中，病情会持续到成年期。这些患者哮喘持续时间较长是哮喘控制不佳的一个危险因素。然而，自儿童期起就持续存在哮喘的成年患者的特征尚未得到充分记录。
我们试图比较成年起病哮喘患者、儿童哮喘已缓解但复发的患者以及自儿童期起就持续存在哮喘的患者的临床特征。
我们对到我院就诊的成年哮喘患者进行了一项横断面研究。我们将他们分为3组：成年起病哮喘患者（成年起病组）、儿童哮喘已缓解但复发的患者（复发组）以及自儿童期起就持续存在哮喘的患者（持续组）。比较了这些组的临床特征。
共纳入1443例患者。持续组患者年龄较小，有吸烟史的患者较少。三组之间哮喘家族史以及过敏性鼻炎和特应性皮炎合并症患者的百分比存在统计学显著差异。三组中重度哮喘患者的比例不同（成年起病组为31%，复发组为34%，持续组为40%；P = 0.015）。持续组在肺活量75%时的用力呼气流量值低于复发组或成年起病组。每组的多变量逻辑回归分析（因变量：重度哮喘）显示，成年起病组、复发组和持续组中与重度哮喘相关的因素不同。当我们建立一个包含队列与其他因素交互项的总体模型时，有一个趋势是，与其他组相比，过敏性鼻炎合并症对复发组哮喘严重程度的影响不同。
从儿童期持续到成年期的哮喘临床表型似乎是成年哮喘的一种独特表型。
