Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong.
Pediatr Allergy Immunol. 2022 Feb;33(2):e13726. doi: 10.1111/pai.13726.
A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma.
Chinese asthmatic children aged 6-15 years from pediatric allergy clinic underwent annual visits for ≥5 years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2 years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence.
181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth.
Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.
一部分哮喘患儿会在成年后痊愈，但目前对于哮喘持续存在的预测因素仍知之甚少。本前瞻性研究旨在描述儿童哮喘患者的肺功能指标变化轨迹，并确定哮喘持续存在的预测因素。
来自儿科过敏诊所的 6-15 岁哮喘患儿接受了为期 5 年及以上的年度随访，直至成年。在基线时和随后至少每年记录一次支气管扩张剂前的肺量计检查和抗哮喘药物使用情况。当患者无症状且停用抗哮喘药物≥2 年时，定义为哮喘缓解。采用 logistic 回归分析确定哮喘持续存在的预测因素。采用广义估计方程分析与哮喘持续存在相关的肺功能参数的纵向变化。
181 例哮喘患儿（平均年龄 10.0 [2.7] 岁）接受了平均（标准差）12.5（2.8）年的随访。随访期间有三分之一的患儿哮喘痊愈。女性患儿持续哮喘的可能性是男性的 3.36 倍。曾使用吸入性皮质类固醇（ICS）治疗和频繁哮喘急性加重（AE）与哮喘持续存在的比值比分别为 3.19（95%置信区间 [CI] 1.44-7.09）和 3.05（95% CI 1.39-6.68）。基线时用力呼气量（FEV%）与哮喘持续存在呈负相关，比值比为 0.96（95% CI 0.93-1.00）。在整个随访期间，持续哮喘患儿的用力呼气指数通常低于哮喘缓解患儿。持续哮喘患儿的肺功能增长较差。
女性、曾使用 ICS 和频繁 AE 预测哮喘持续存在。持续哮喘患儿的用力呼气指数较低，肺功能增长到成年期较差。
