Kaas Trine H, Vinding Rebecca K, Stokholm Jakob, Bønnelykke Klaus, Bisgaard Hans, Chawes Bo L
COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Clin Exp Allergy. 2021 Feb;51(2):228-252. doi: 10.1111/cea.13750. Epub 2020 Oct 13.
Children with asthma are at risk of depression and anxiety and growing evidence suggest they may also be at risk of attention deficit hyperreactivity disorder (ADHD) and autism spectrum disorder (ASD). Here, we conducted a systematic review with meta-analysis of studies investigating association between asthma and ADHD or ASD in children.
A comprehensive search using PubMed, EMBASE and Cochrane Library databases was completed in March 2019. Observational human studies published in English, clinic-based or population-based with a healthy comparator group, evaluating asthma-ADHD or asthma-ASD overlap in children 18 years or younger using categorical diagnoses (yes/no) were considered for inclusion. Random effects meta-analysis models were used to analyse data. The Newcastle Ottawa Scale was used to evaluate risk of bias.
A total of 25 asthma-ADHD studies were included of which 17 showed significant positive associations and one a negative association: 17/25 studies were population-based, 19/25 were cross-sectional or cohort studies and 7/25 had a low risk of bias. We performed a meta-analysis of 23 of the studies, which showed a significant association between asthma and ADHD: odds ratio (OR) 1.52 (1.42-1.63), P < .001, I2 = 60%. All studies were adjusted for age and sex and a large proportion; that is, 19/23 were further adjusted for relevant confounders. Seventeen asthma-ASD studies were included, whereof 7 showed a positive association and 3 a negative association; 8/17 were population-based with a cross-sectional study design and 4/17 had a low risk of bias. We performed a meta-analysis of 14 of the studies, which did not show a significant association between asthma and ASD: OR 1.12 (0.93-1.34), P = .24, I2 = 89%. All studies were adjusted for age and sex and 10/14 were further adjusted for relevant confounders.
This systematic review with meta-analyses shows a significant overlap between asthma and ADHD, but not between asthma and ASD in children. Clinicians taking care of children with asthma or ADHD should be aware of such association to aid an early diagnosis and treatment of such comorbidity.
哮喘患儿有患抑郁症和焦虑症的风险，越来越多的证据表明，他们也可能有患注意力缺陷多动障碍（ADHD）和自闭症谱系障碍（ASD）的风险。在此，我们对调查儿童哮喘与ADHD或ASD之间关联的研究进行了系统综述和荟萃分析。
2019年3月，我们使用PubMed、EMBASE和Cochrane图书馆数据库进行了全面检索。纳入以英文发表的观察性人体研究，这些研究基于诊所或人群，设有健康对照组，使用分类诊断（是/否）评估18岁及以下儿童哮喘与ADHD或哮喘与ASD的重叠情况。采用随机效应荟萃分析模型分析数据。使用纽卡斯尔渥太华量表评估偏倚风险。
共纳入25项哮喘与ADHD的研究，其中17项显示显著正相关，1项显示负相关：25项研究中有17项基于人群，19项为横断面或队列研究，25项中有7项偏倚风险较低。我们对其中23项研究进行了荟萃分析，结果显示哮喘与ADHD之间存在显著关联：比值比（OR）为1.52（1.42 - 1.63），P <.001，I² = 60%。所有研究均对年龄和性别进行了调整，且大部分研究（即23项中的19项）进一步对相关混杂因素进行了调整。纳入17项哮喘与ASD的研究，其中7项显示正相关，3项显示负相关；17项中有8项基于人群，采用横断面研究设计，17项中有4项偏倚风险较低。我们对其中14项研究进行了荟萃分析，结果显示哮喘与ASD之间无显著关联：OR为1.12（0.93 - 1.34），P = 0.24，I² = 89%。所有研究均对年龄和性别进行了调整，14项中有10项进一步对相关混杂因素进行了调整。
这项系统综述和荟萃分析表明，儿童哮喘与ADHD之间存在显著重叠，但哮喘与ASD之间不存在显著重叠。照顾哮喘或ADHD患儿的临床医生应了解这种关联，以帮助早期诊断和治疗这种合并症。
