University of California San Francisco, School of Medicine (A Martinez, Y Ye, D Hessler, R de la Rosa, and N Thakur).
UCSF Benioff Children's Hospital Oakland (M Benson and D Long), Oakland, Calif.
Acad Pediatr. 2024 May-Jun;24(4):669-676. doi: 10.1016/j.acap.2024.01.010. Epub 2024 Jan 19.
To examine the association between adverse childhood experiences (ACEs) and related events and asthma symptom burden in children.
This is a cross-sectional study of baseline data from 147 participants with asthma from a cohort of children enrolled in the Pediatric ACEs Screening and Resiliency Study. Participants completed the PEdiatric ACEs and Related Life Events Screener (PEARLS) tool, a 17-item questionnaire, capturing 3 domains of childhood adversity-child maltreatment, household challenges, and social context. Asthma symptom burden was assessed using the International Study of Asthma and Allergies in Childhood core questionnaire, which asks participants to identify the presence and frequency of severe wheezing that limits speech, wheezing with exercise, nocturnal wheezing, and nocturnal cough in the last 12 months. Using multivariable logistical regression models, we examined the relationship between reported PEARLS and asthma symptoms.
Of children with asthma, 86% reported at least 1 adversity, with 48% reporting 4 or more. The odds of severe wheeze limiting speech increased by 19% with each additional reported adversity captured by the PEARLS tool (95% confidence intervals (CI) 1.01-1.41). Increasing PEARLS scores were also associated with 16% increased odds of reporting wheeze with exercise (95% CI 1.03-1.31). Wheezing with exercise was associated with the household challenges domain (odds ratio (OR) 1.34; 95% CI 1.05-1.72), while severe wheeze limiting speech was associated with the social context domain (OR 1.75; 95%CI 1.02-3.02).
Childhood adversities are associated with increased asthma symptom burden, suggesting the tool may be helpful in identifying children at risk for poorly controlled asthma.
探讨儿童期不良经历（ACEs）及相关事件与哮喘症状负担的关系。
这是一项横断面研究，纳入了儿科 ACEs 筛查和适应力研究队列中 147 名哮喘患儿的基线数据。参与者完成了儿科 ACEs 及相关生活事件筛查工具（PEARLS），这是一个包含 3 个领域的 17 项问卷，分别是儿童虐待、家庭挑战和社会环境。哮喘症状负担采用国际儿童哮喘和过敏研究核心问卷进行评估，询问参与者过去 12 个月内是否出现严重限制言语的喘息、运动后喘息、夜间喘息和夜间咳嗽，以及其发生频率。我们使用多变量逻辑回归模型，检验报告的 PEARLS 与哮喘症状之间的关系。
哮喘患儿中，86%报告至少存在 1 种逆境，48%报告存在 4 种或更多逆境。PEARLS 工具报告的逆境每增加 1 项，严重限制言语的喘息发生几率增加 19%（95%置信区间[CI] 1.01-1.41）。PEARLS 评分增加也与报告运动后喘息的几率增加 16%相关（95% CI 1.03-1.31）。运动后喘息与家庭挑战领域相关（比值比[OR] 1.34；95% CI 1.05-1.72），而严重限制言语的喘息与社会环境领域相关（OR 1.75；95%CI 1.02-3.02）。
儿童期逆境与哮喘症状负担增加相关，提示该工具可能有助于识别哮喘控制不佳的高风险儿童。
