Wan Joy, Wang Sonia, Shin Daniel B, Syed Maha N, Abuabara Katrina, Lemeshow Adina R, Gelfand Joel M
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
J Allergy Clin Immunol Pract. 2024 Feb;12(2):421-430.e1. doi: 10.1016/j.jaip.2023.11.009. Epub 2023 Nov 14.
Atopic dermatitis (AD) is thought to induce asthma via the "atopic march," but the effects of AD on incident asthma and asthma severity have not been fully characterized.
To determine risk of asthma, asthma exacerbations, and asthma-related hospitalizations among patients fwith AD.
A cohort study was conducted using electronic health records data from UK general practices from 1994 to 2015. Children (<18 years old) and adults (≥18 years) with AD were matched on age, practice, and index date to patients without AD. AD severity was categorized using treatments and dermatologist referrals. Outcomes were incident asthma among all patients and asthma exacerbation or hospitalization among patients with asthma.
On comparing 409,341 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) with 1,809,029 unaffected children, those with AD were found to be associated with a 2-fold greater risk of asthma compared with those without AD (hazard ratio, 1.96; 95% CI, 1.93-1.98). On comparing 625,083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe) with 2,678,888 unaffected adults, AD was found to be associated with a 38% higher risk of asthma (hazard ratio, 1.38; 95% CI, 1.36-1.40). Asthmatic patients with AD also had a 21% to 63% greater risk of asthma exacerbations and a 20% to 64% greater risk of asthma-related hospitalizations compared with asthmatic patients without AD. Risk of asthma, asthma exacerbation, or asthma-related hospitalization increased with AD severity in a dose-dependent manner in both the pediatric and adult cohorts.
AD, especially in children and when more severe, is associated with greater risk of asthma as well as greater risk of asthma exacerbations and hospitalizations among asthmatic patients.
特应性皮炎（AD）被认为通过“特应性进程”诱发哮喘，但AD对哮喘发病及哮喘严重程度的影响尚未完全明确。
确定AD患者发生哮喘、哮喘加重及与哮喘相关住院的风险。
利用1994年至2015年英国全科医疗的电子健康记录数据进行队列研究。将患有AD的儿童（<18岁）和成人（≥18岁）按年龄、医疗机构及索引日期与未患AD的患者进行匹配。AD严重程度根据治疗情况和皮肤科医生转诊进行分类。结局指标为所有患者中的哮喘发病情况以及哮喘患者中的哮喘加重或住院情况。
将409,341例患有AD的儿童（93.2%为轻度，5.5%为中度，1.3%为重度）与1,809,029例未受影响的儿童进行比较，发现患有AD的儿童患哮喘的风险是未患AD儿童的2倍（风险比，1.96；95%置信区间，1.93 - 1.98）。将625,083例患有AD的成人（65.7%为轻度，31.4%为中度，2.9%为重度）与2,678,888例未受影响的成人进行比较，发现AD与哮喘风险升高38%相关（风险比，1.38；95%置信区间，1.36 - 1.40）。与未患AD的哮喘患者相比，患AD的哮喘患者哮喘加重风险高21%至63%，与哮喘相关的住院风险高20%至64%。在儿童和成人队列中，哮喘、哮喘加重或与哮喘相关住院的风险均随AD严重程度增加而呈剂量依赖性增加。
AD，尤其是在儿童中以及病情更严重时，与哮喘风险增加以及哮喘患者中哮喘加重和住院风险增加相关。
