Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health & Science University, Portland, Ore.
Department of Pediatrics, School of Medical School, University of Western Australia, Crawley, Western Australia, Australia; Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.
J Allergy Clin Immunol Pract. 2023 Mar;11(3):677-683. doi: 10.1016/j.jaip.2023.01.014. Epub 2023 Jan 25.
Longitudinal studies have demonstrated that altered indices of airway function, assessed shortly after birth, are a risk factor for the subsequent development of wheezing illnesses and asthma, and that these indices predict airway size and airway wall thickness in adult life. Pre- and postnatal factors that directly alter early airway function, such as extreme prematurity and cigarette smoke, may continue to affect airway function and, hence, the risks for wheeze and asthma. Early airway function and an associated asthma risk may also be indirectly influenced by immune system responses, respiratory viruses, the airway microbiome, genetics, and epigenetics, especially if they affect airway epithelial dysfunction. Few if any interventions, apart from smoking avoidance, have been proven to alter the risks of developing asthma, but vitamin C supplementation to pregnant smokers may help decrease the effects of in utero smoke on offspring lung function. We conclude that airway size and the factors influencing this play an important role in determining the risk for asthma across the lifetime. Progress in asthma prevention is long overdue and this may benefit from carefully designed interventions in well-phenotyped longitudinal birth cohorts with early airway function assessments monitored through to adulthood.
纵向研究表明，出生后不久评估的气道功能改变指标是随后发生喘息性疾病和哮喘的危险因素，并且这些指标可以预测成年后的气道大小和气道壁厚度。直接改变早期气道功能的产前和产后因素，如极度早产和吸烟，可能会继续影响气道功能，从而影响喘息和哮喘的风险。早期气道功能和相关的哮喘风险也可能受到免疫系统反应、呼吸道病毒、气道微生物组、遗传和表观遗传学的间接影响，尤其是如果它们影响气道上皮功能障碍。除了避免吸烟之外，几乎没有任何干预措施被证明可以改变发生哮喘的风险，但给吸烟的孕妇补充维生素 C 可能有助于减少宫内吸烟对后代肺功能的影响。我们的结论是，气道大小和影响气道大小的因素在一生中决定哮喘风险方面起着重要作用。哮喘预防的进展已经严重滞后，这可能得益于在具有早期气道功能评估的特征明确的纵向出生队列中进行精心设计的干预措施，这些队列一直监测到成年。
