Université de Paris, Institut Necker-Enfants Malades, Equipe Immunorégulation et Immunopathologie, Inserm UMR1151, CNRS UMR8253, Paris, France; Service de Pneumologie et Allergologie Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
Univ. Lille, CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France; Univ. Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, Lille, France.
J Allergy Clin Immunol Pract. 2021 May;9(5):1969-1979. doi: 10.1016/j.jaip.2020.12.027. Epub 2020 Dec 24.
Severe asthma (SA) in children is a complex, heterogeneous disease, associated with a considerable burden. However, factors influencing asthma severity are poorly described and may differ according to age.
To determine whether factors associated with asthma severity differ between preschoolers with severe recurrent wheeze (SRW) and school-age children with SA.
Data from the French multicenter prospective observational cohort of preschool (3-6 years) children with SRW and nonsevere recurrent wheeze (NSRW) and school-age (7-11 years) children with SA and nonsevere asthma (NSA) (Pediatric Cohort of Bronchial Obstruction and Asthma) were analyzed.
A total of 131 preschool children (92 SRW and 49 NSRW) and 207 school-age children (92 SA and 115 NSA) were included. In both univariable and multivariable analysis, SRW was associated with second-hand smoke exposure (multivariable analysis: odds ratio [95% CI], 29.8 [3.57-3910]) and exposure to mold/dampness at home (multivariable analysis: odds ratio [95% CI], 4.22 [1.25-18.2]) compared with NSRW. At school-age, history of atopic dermatitis and food allergy was more frequent in children with SA than in those with NSA. Multivariable analysis confirmed that SA was associated with a history of food allergy (odds ratio [95% CI], 5.01 [2.23-11.9]).
Our data suggest that factors influencing asthma severity may differ according to age. In preschool children with SRW, second-hand smoke and exposure to mold are predominant, whereas associated allergic disorders are mainly involved in SA at school-age.
儿童重度哮喘（SA）是一种复杂的、异质性疾病，与相当大的负担相关。然而，影响哮喘严重程度的因素描述较差，并且可能因年龄而异。
确定学龄前儿童重度反复喘息（SRW）和学龄儿童 SA 中与哮喘严重程度相关的因素是否存在差异。
分析了来自法国多中心前瞻性观察性学龄前（3-6 岁）儿童 SRW 和非重度反复喘息（NSRW）以及学龄（7-11 岁）儿童 SA 和非重度哮喘（NSA）（Bronchial Obstruction and Asthma 儿科队列）的儿童数据。
共纳入 131 名学龄前儿童（92 名 SRW 和 49 名 NSRW）和 207 名学龄儿童（92 名 SA 和 115 名 NSA）。在单变量和多变量分析中，与 NSRW 相比，SRW 与二手烟暴露（多变量分析：优势比[95%置信区间]，29.8 [3.57-3910]）和家中霉菌/潮湿暴露（多变量分析：优势比[95%置信区间]，4.22 [1.25-18.2]）相关。在学龄期，与 NSA 相比，SA 患儿更常患有特应性皮炎和食物过敏史。多变量分析证实，SA 与食物过敏史相关（优势比[95%置信区间]，5.01 [2.23-11.9]）。
我们的数据表明，影响哮喘严重程度的因素可能因年龄而异。在学龄前儿童 SRW 中，二手烟和霉菌暴露为主，而学龄期的相关过敏疾病主要与 SA 有关。
