Yamada Shingo, Fujisawa Takao, Nagao Mizuho, Matsuzaki Hiroshi, Motomura Chikako, Odajima Hiroshi, Nakamura Toshinori, Imai Takanori, Nagakura Ken-Ichi, Yanagida Noriyuki, Mitomori Masatoshi, Ebisawa Motohiro, Kabashima Shigenori, Ohya Yukihiro, Habukawa Chizu, Tomiita Minako, Hirayama Masahiro
Allergy Center, National Hospital Organization Mie National Hospital, Tsu 514-0125, Japan.
Allergy Center, National Hospital Organization Mie National Hospital, 357 Ozato-kubota, Tsu 514-0125, Japan.
Children (Basel). 2022 Oct 4;9(10):1516. doi: 10.3390/children9101516.
Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6−9, 10−12, and 13−15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups. Results: Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13−15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10−12 years and high-dose ICS use during 13−15 years were associated with a favorable outcome (Group N/U). Conclusion: We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA.
儿童哮喘是成年后期肺功能低下的主要风险因素，但哮喘中的哪些因素与儿童期肺功能差相关尚不清楚。目的：确定哮喘儿童在治疗期间与肺功能低下或下降相关的临床因素。方法：我们纳入了在日本七家专科医院接受过三个年龄段（即6 - 9岁、10 - 12岁和13 - 15岁）治疗的哮喘儿童。从电子病历系统中检索临床信息和肺功能测量数据。为了描述每个年龄段的肺功能轨迹，我们用预测值百分比评估第一秒用力呼气容积（FEV1），并通过线性回归的斜率（S）评估个体变化。我们定义了四种轨迹模式：正常（N组）和低水平（L组），在所有三个时期均显示FEV1%≥80%或<80%；上升（U组）和下降（D组），显示S≥0或S<0%。进行逻辑回归分析以比较与不良（D/L）组和良好（N/U）组相关的因素。结果：在273名符合条件的患者中，197名（72%）被分类为N组（n = 150）/U组（n = 47），而76名（28%）属于D组（n = 66）/L组（n = 10）。哮喘控制不佳史、长效β2激动剂的使用以及13 - 15岁期间较低的身高Z评分与不良结局（D/L组）相关。相反，10 - 12岁期间吸入糖皮质激素（ICS）的使用以及13 - 15岁期间高剂量ICS的使用与良好结局（N/U组）相关。结论：我们确定了几个与儿童哮喘肺功能不良变化相关的因素。应关注肺功能的年度变化与哮喘控制不佳、ICS的使用（及其剂量）和长效β2激动剂的使用之间的可能关系。
