Liu Lu, Ma Hui, Yuan Shuhua, Zhang Jing, Wu Jinhong, Dilimulati Muheremu, Wang Yahua, Shen Shiyu, Zhang Lei, Lin Jilei, Yin Yong
Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Pediatr. 2023 Jan 9;10:1043047. doi: 10.3389/fped.2022.1043047. eCollection 2022.
To follow up on the changes in pulmonary function phenotypes in children with asthma in the first year after diagnosis, and explore the risk factors of poor control in children with good treatment compliance.
Children who were diagnosed with asthma in the Respiratory Department of Shanghai Children's Medical Center from January 1, 2019 to December 31, 2020 and were re-examined every 3 months after diagnosis for 1 year were continuously included, regardless of gender. We collected the clinical data, analyzed clinical characteristics of the different pulmonary function phenotypes at baseline and explored risk factors of poor asthma control after 1 year of standardized treatment.
A total of 142 children with asthma were included in this study, including 54 (38.0%) with normal pulmonary function phenotype (NPF), 75 (52.8%) with ventilation dysfunction phenotype (VD), and 13 (9.2%) with small airway dysfunction phenotype (SAD) in the baseline. Among them, there were statistically significant differences in all spirometry parameters, age, and course of disease before diagnosis ( < 0.05), and a negative correlation between age ( = -0.33, < 0.001), course of disease before diagnosis ( = -0.23, = 0.006) and FEV/FVC. After 1-year follow-up, large airway function parameters and small airway function parameters were increased, fractional exhaled nitric oxide (FeNO) was decreased, the proportion of NPF was increased, the proportion of VD was decreased ( < 0.05), while there was no significant difference in the proportion of SAD. After 1 year of standardized treatment, 21 patients (14.8%) still had partly controlled or uncontrolled asthma. Our results showed that the more asthma attacks occurred within 1 year (OR = 6.249, 95% CI, 1.711-22.818, = 0.006), the more times SAD presented at baseline and Assessment 1-4 (OR = 3.092, 95% CI, 1.222-7.825, = 0.017), the higher the possibility of incomplete control of asthma.
About 15% of the children with good treatment compliance were still not completely controlled after 1 year of treatment, which is closely associated with persistent small airway dysfunction.
随访哮喘患儿确诊后第1年肺功能表型的变化，并探讨治疗依从性良好的患儿控制不佳的危险因素。
连续纳入2019年1月1日至2020年12月31日在上海儿童医学中心呼吸科确诊为哮喘且确诊后每3个月复查1年的患儿，不限性别。收集临床资料，分析基线时不同肺功能表型的临床特征，并探讨标准化治疗1年后哮喘控制不佳的危险因素。
本研究共纳入142例哮喘患儿，基线时肺功能表型正常（NPF）者54例（38.0%），通气功能障碍表型（VD）者75例（52.8%），小气道功能障碍表型（SAD）者13例（9.2%）。其中，所有肺量计参数、年龄及确诊前病程差异均有统计学意义（<0.05），年龄（=-0.33，<0.001）、确诊前病程（=-0.23，=0.006）与FEV/FVC呈负相关。随访1年后，大气道功能参数和小气道功能参数升高，呼出一氧化氮分数（FeNO）降低，NPF比例升高，VD比例降低（<0.05），而SAD比例差异无统计学意义。标准化治疗1年后，21例患者（14.8%）哮喘仍部分控制或未控制。结果显示，1年内哮喘发作次数越多（OR=6.249，95%CI，1.711-22.818，=0.006），基线及评估1-4时SAD出现次数越多（OR=3.092，95%CI，1.222-7.825，=0.017），哮喘未完全控制的可能性越高。
约15%治疗依从性良好的患儿治疗1年后仍未完全控制，这与持续性小气道功能障碍密切相关。
