因哮喘及其他特应性疾病转诊的儿童中未控制哮喘的患病率及预测因素
Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases.
作者信息
Kansen H M, Le T M, Uiterwaal Cspm, van Ewijk B E, Balemans Waf, Gorissen Dmw, de Vries E, van Velzen M F, Slabbers Ghpr, Meijer Y, Knulst A C, van der Ent C K, van Erp F C
机构信息
Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
J Asthma Allergy. 2020 Jan 30;13:67-75. doi: 10.2147/JAA.S231907. eCollection 2020.
BACKGROUND
Uncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma.
METHODS
All children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses.
RESULTS
We included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively).
CONCLUSION
Uncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.
背景
尽管有有效的哮喘治疗方法，但儿童未控制的哮喘仍然非常普遍。我们调查了1）在二级医疗机构中，因哮喘就诊以及因哮喘以外的特应性疾病（即食物过敏、过敏性鼻炎或特应性皮炎）就诊的儿童中未控制哮喘的患病率；以及2）与未控制哮喘相关的预测因素。
方法
邀请荷兰8个二级医疗机构中因哮喘或哮喘以外的特应性疾病就诊的所有儿童（4至18岁）进入电子门户（EP）。该EP是一个基于网络的应用程序，包含多个经过验证的问卷，包括国际儿童哮喘和过敏研究（ISAAC）问卷以及哮喘控制测试（ACT）。当孩子的父母在EP中报告他们的孩子已被医生诊断为哮喘时，该孩子有资格纳入本研究。ACT用于评估哮喘控制情况。通过单变量和多变量逻辑回归分析评估哮喘控制的多个预测因素（患者、哮喘和特应性特征）。
结果
我们纳入了408名儿童：259名（63%）因哮喘就诊的哮喘儿童和149名（37%）因哮喘以外的特应性疾病就诊的哮喘儿童。所有儿童中有39%患有未控制的哮喘：因哮喘就诊的儿童中有47%，因哮喘以外的特应性疾病就诊的儿童中有26%。与未控制哮喘相关的预测因素是哮喘家族史（比值比[OR]2.08；95%置信区间[95%CI]1.34至3.24），以及过去一年中反复出现的上、下呼吸道感染（分别为OR 2.40；95%CI 1.52至3.81和OR 2.00；95%CI 1.25至3.23）。
结论
在转诊至二级医疗机构的哮喘儿童中，未控制的哮喘非常普遍，即使这些儿童最初是因哮喘以外的特应性疾病就诊。因此，应关注该人群的哮喘控制情况。
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