Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.
Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.
Lancet Child Adolesc Health. 2023 Jun;7(6):429-440. doi: 10.1016/S2352-4642(23)00030-5. Epub 2023 Apr 7.
Early childhood respiratory infections, including pneumonia, are an important global public health issue, with more than 40 million annual cases resulting in approximately 650 000 deaths. A growing number of published studies have examined the effects of early childhood lower respiratory tract infections (LRTIs) or pneumonia on lung function, particularly as part of large early-life exposure studies. To our knowledge, there is no published systematic review of these data. We searched PubMed, Embase, and Web of Science for studies published between database inception and May 12, 2022. Case-control, cohort, and cross-sectional studies were included if they reported forced expiratory volume in 1 s (FEV) or forced vital capacity (FVC) values of participants older than 5 years. Article titles and abstracts were screened in Rayyan before retrieval, assessment, and data extraction of the full text. Primary outcome measures were differences in mean FEV or FVC values between exposed groups (ie, children aged ≤5 years with LRTIs) and non-exposed groups. This study is registered with PROSPERO, CRD42021265295. Database searches yielded 3070 articles, and 14 studies were included in this systematic review, providing a total of 23 276 participants, including 9969 children and 13 307 adults. Eight of 14 articles reported significant reductions in FEV values, and six of 12 studies reported reductions in FVC values in children and adults with a history of early childhood LRTIs or pneumonia, compared with unexposed controls (p<0·05). Most studies reporting reductions in lung function described deficits consistent with a restrictive spirometry pattern. Only two of 14 studies reported data from low-income and middle-income countries or disadvantaged populations in middle-income and high-income countries, and there were scarce data available on the effect of LRTI severity and recurrence on lung function. LRTIs in early childhood could be associated with a restrictive spirometry pattern in later childhood and adulthood. Data are needed from low-income and middle-income nations, and from disadvantaged populations in middle-income and high-income countries in which early childhood respiratory infection burden is disproportionately high. Data are also needed on the effect of LRTI severity and recurrence on future lung function.
儿童期呼吸道感染，包括肺炎，是一个重要的全球公共卫生问题，每年有超过 4000 万例病例，导致约 65 万人死亡。越来越多的已发表的研究已经研究了儿童期下呼吸道感染（LRTIs）或肺炎对肺功能的影响，特别是作为大型生命早期暴露研究的一部分。据我们所知，目前还没有关于这些数据的系统评价。我们在 PubMed、Embase 和 Web of Science 中检索了从数据库建立到 2022 年 5 月 12 日发表的研究。如果研究报告了 5 岁以上参与者的 1 秒用力呼气量（FEV）或用力肺活量（FVC）值，则纳入病例对照、队列和横断面研究。文章标题和摘要在 Rayyan 中进行筛选，然后检索全文进行评估和数据提取。主要结局指标是暴露组（即 5 岁以下患有 LRTIs 的儿童）与非暴露组之间 FEV 或 FVC 值的平均差异。这项研究在 PROSPERO 上注册，CRD42021265295。数据库检索产生了 3070 篇文章，14 项研究被纳入本系统评价，共纳入 23276 名参与者，包括 9969 名儿童和 13307 名成人。14 篇文章中有 8 篇报告了 FEV 值的显著降低，12 项研究中有 6 项报告了儿童和成人的 FVC 值降低，与未暴露的对照组相比（p<0.05）。大多数报告肺功能降低的研究描述了与限制性肺量计模式一致的缺陷。在 14 项研究中只有 2 项报告了来自低收入和中等收入国家或中等收入和高收入国家弱势群体的数据，关于 LRTI 严重程度和复发对肺功能的影响的数据很少。儿童期 LRTI 可能与儿童后期和成年期的限制性肺量计模式有关。需要来自低收入和中等收入国家的数据，以及来自中低收入国家弱势群体的数据，因为这些国家的儿童期呼吸道感染负担不成比例地高。还需要关于 LRTI 严重程度和复发对未来肺功能的影响的数据。
