Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Starship Children's Health and Kidz First Hospital, Auckland, New Zealand.
Eur Respir Rev. 2024 Apr 10;33(172). doi: 10.1183/16000617.0222-2023. Print 2024 Apr 30.
Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.
呼吸症状在儿童中普遍存在，尽管它们可能预示着长期预后不良，但往往被轻视。在受孕前、产前和幼儿期的不良暴露对呼吸健康有终身影响。在大多数情况下，肺功能从学前至少到中年后期都有一定的轨迹，气流阻塞不仅与不良的呼吸结局有关，而且还与早期全因发病率和死亡率有关。如果能够解决不良结果的社会决定因素，那么很多情况都是可以预防的。本综述介绍了来自不同收入背景的儿科医生的观点，包括欧洲、美洲、澳大拉西亚、印度、非洲和中国。需要注意的是，即使在收入最高的国家，也存在贫困的孤岛，而在最贫困的国家，也有富裕的地区。任何不利影响的最大负担都落在社会经济地位最低的人群身上。主题包括在整个发育过程中被动暴露于烟草烟雾和室内外污染，以及即使是最基本的负担得起的药物也无法获得，更不用说新的生物制剂了。通常，资源匮乏地区的疾病结局更差。无论是在国家内部还是国家之间，疾病结局都存在明显的不公平现象。气候变化对最贫困的儿童影响最大。本综述强调了为改善儿童终身健康而积极倡导的必要性。它还强调，已经有针对疾病社会决定因素的文化敏感干预措施正在使儿童受益。
