Andersén Heidi, Ilmarinen Pinja, Honkamäki Jasmin, Tuomisto Leena E, Hisinger-Mölkänen Hanna, Backman Helena, Lundbäck Bo, Rönmark Eva, Lehtimäki Lauri, Sovijärvi Anssi, Piirilä Päivi, Kankaanranta Hannu
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Etelä-Pohjanmaa, Finland.
J Asthma Allergy. 2021 Sep 7;14:1081-1091. doi: 10.2147/JAA.S323504. eCollection 2021.
Asthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis.
A cross-sectional population-based study was carried out with subjects aged 20-69 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (0-11 years), intermediate diagnosis (12-39 years), and late diagnosis (40-69 years).
The prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, ex-smoker, occupational exposure, and BMI ≥ 30 kg/m were associated with a higher likelihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87-1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12-4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30-0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47-1.18).
Odds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late.
哮喘是一种异质性疾病，与不同哮喘表型相关的因素尚不清楚。鉴于芬兰西部农村地区与首都赫尔辛基相比，农业接触的患病率较高且哮喘诊断较晚，我们调查了儿童时期的农业环境与哮喘诊断年龄之间的关系。
在芬兰西部对20 - 69岁的人群进行了一项基于人群的横断面研究。应答率为52.5%。我们纳入了3864名参与者，其中416人在已知年龄被医生诊断为哮喘且有儿童时期环境的数据。在赫尔辛基的一个类似样本中证实了主要发现。参与者根据哮喘诊断情况分为以下几类：早期诊断（0 - 11岁）、中期诊断（12 - 39岁）和晚期诊断（40 - 69岁）。
无论儿童时期是否接触农业环境，哮喘患病率相似（11.7%对11.3%）。过敏性鼻炎、哮喘家族史、既往吸烟者、职业接触和体重指数≥30 kg/m²与哮喘发生的可能性较高相关。儿童时期接触农业环境并未增加患哮喘的几率（调整后的比值比，1.10；95%置信区间，0.87 - 1.40）。它确实增加了晚期诊断的几率（调整后的比值比，2.30；95%置信区间，1.12 - 4.69），但对于哮喘的早期（调整后的比值比，0.49；95%置信区间，0.30 - 0.80）和中期诊断（调整后的比值比，0.75；95%置信区间，0.47 - 1.18）几率较低。
在儿童农业环境中，哮喘早期诊断的几率较低，晚期诊断的几率较高。这提示了一个关于哮喘晚期诊断病因的新假说。
