Mansbach Jonathan M, Ying Qi Shelly, Espinola Janice A, Hasegawa Kohei, Sullivan Ashley F, Camargo Carlos A
Department of Pediatrics, Boston Children's Hospital, Boston.
Department of Emergency Medicine, Massachusetts General Hospital, Boston.
J Allergy Clin Immunol Glob. 2023 Feb;2(1):84-87. doi: 10.1016/j.jacig.2022.08.008. Epub 2022 Nov 21.
Recurrent wheezing, a common diagnosis after severe bronchiolitis, has multiple phenotypes of uncertain relation to childhood asthma.
Among infants hospitalized for bronchiolitis, we investigated the relation of three 2020 recurrent wheezing phenotypes by age 4 years to asthma by age 6 years.
In a 17-center cohort study of infants hospitalized with bronchiolitis, we investigated the National Heart, Lung, and Blood Institute (NHLBI) 2020-defined recurrent wheezing phenotype and 2 additional phenotypes based on this definition: multitrigger and severe. As a sensitivity analysis, we examined the NHLBI 2007 recurrent wheezing phenotype. We calculated the proportion of study subjects who developed asthma by age 6 years and used multivariable logistic regression to examine characteristics associated with the highest-risk 2020 phenotype.
Of 921 infants, 632 (69%) developed NHLBI 2020 recurrent wheezing, 734 (80%) developed multitrigger wheezing, and 165 (18%) developed severe wheezing by age 4 years; in addition, 296 (32%) developed NHLBI 2007-defined recurrent wheezing by age 3 years. Of 862 children with sufficient data (94%), 239 (28%) developed asthma by age 6 years. The proportions of children who progressed to asthma were as follows: 33% of those with NHLBI 2020-defined wheezing, 33% of those with multitrigger wheezing, 54% of those with severe wheezing, and 52% of those with NHLBI 2007-defined recurrent wheezing. The children with the severe phenotype who developed asthma had the associated characteristics preterm birth, child eczema, maternal asthma, and non-respiratory syncytial virus infection.
Most infants with severe bronchiolitis developed the NHLBI 2020-defined recurrent wheezing phenotype by age 4 years. Depending on the phenotype, 33% to 54% will develop asthma by age 6 years. Future research will examine whether earlier treatment of high-risk phenotypes will improve wheezing symptoms and potentially prevent childhood asthma. (J Allergy Clin Immunol Global 2023;2:84-7.).
反复喘息是重症细支气管炎后的常见诊断，其多种表型与儿童哮喘的关系尚不确定。
在因细支气管炎住院的婴儿中，我们研究了4岁时的三种2020年反复喘息表型与6岁时哮喘的关系。
在一项对因细支气管炎住院的婴儿进行的17中心队列研究中，我们调查了美国国立心肺血液研究所（NHLBI）2020年定义的反复喘息表型以及基于该定义的另外两种表型：多触发因素型和严重型。作为敏感性分析，我们检查了NHLBI 2007年的反复喘息表型。我们计算了6岁时患哮喘的研究对象比例，并使用多变量逻辑回归来检查与最高风险的2020年表型相关的特征。
在921名婴儿中，632名（69%）在4岁时出现NHLBI 2020年定义的反复喘息，734名（80%）出现多触发因素型喘息，165名（18%）出现严重喘息；此外，296名（32%）在3岁时出现NHLBI 2007年定义的反复喘息。在862名有足够数据的儿童中（94%），239名（28%）在6岁时患哮喘。进展为哮喘的儿童比例如下：NHLBI 2020年定义的喘息儿童中为33%，多触发因素型喘息儿童中为33%，严重喘息儿童中为54%，NHLBI 2007年定义的反复喘息儿童中为52%。患哮喘的严重表型儿童具有早产、儿童湿疹、母亲哮喘和非呼吸道合胞病毒感染等相关特征。
大多数重症细支气管炎婴儿在4岁时出现NHLBI 2020年定义的反复喘息表型。根据表型不同，33%至54%的婴儿将在6岁时患哮喘。未来的研究将探讨对高风险表型进行早期治疗是否会改善喘息症状并有可能预防儿童哮喘。（《过敏与临床免疫全球杂志》2023年；2：84 - 7。）
