Määttä Anette M, Malmberg L Pekka, Pelkonen Anna S, Mäkelä Mika J
Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Allergy Clin Immunol Glob. 2025 Mar 18;4(2):100454. doi: 10.1016/j.jacig.2025.100454. eCollection 2025 May.
The role of early airway hyperresponsiveness (AHR) in the subsequent small-airway lung function remains unclear.
We assessed via a prospective follow-up study the small-airway lung function of schoolchildren with early childhood lower-airway symptoms and AHR to methacholine and compared the findings to the measurements of reference children with no previous or current lung diseases.
During 2004-11, we measured atopic markers, lung function, and airway responsiveness to methacholine in 193 symptomatic children <3 years old. In 2016-18, a follow-up sample of 84 schoolchildren and 40 reference children were assessed for atopic parameters, spirometry, and small-airway lung function. Analysis was performed on the basis of early childhood AHR, early childhood atopy (defined as a positive skin prick test result), and exposure to parental smoking reported in a questionnaire. All the results were compared with those of the reference group.
Schoolchildren with early childhood lower-airway symptoms and AHR had higher prebronchodilator area under the reactance curve (AX) score, lower forced expiratory flow at 50% of forced vital capacity (FEF) score, and higher lung clearance index (LCI) 2.5% compared with those without early childhood AHR and reference children. Moreover, AX and FEF scores only partly improved after bronchodilation. Early childhood atopy and exposure to parental smoking were not associated with school-age small-airway dysfunction.
AHR in symptomatic young children associated with subsequent persistent small-airway dysfunction. Further studies with larger samples of symptomatic young children are warranted to determine whether this connection predicts the development of asthma or other obstructive pulmonary diseases as the children grow.
早期气道高反应性（AHR）在随后的小气道肺功能中的作用尚不清楚。
我们通过一项前瞻性随访研究评估了患有幼儿期下呼吸道症状且对乙酰甲胆碱有AHR的学童的小气道肺功能，并将结果与没有既往或当前肺部疾病的参照儿童的测量结果进行比较。
在2004年至2011年期间，我们测量了193名3岁以下有症状儿童的特应性标志物、肺功能和对乙酰甲胆碱的气道反应性。在2016年至2018年期间，对84名学童和40名参照儿童的随访样本进行了特应性参数、肺活量测定和小气道肺功能评估。根据幼儿期AHR、幼儿期特应性（定义为皮肤点刺试验结果为阳性）以及问卷中报告的父母吸烟暴露情况进行分析。所有结果均与参照组进行比较。
与没有幼儿期AHR的儿童和参照儿童相比，患有幼儿期下呼吸道症状且有AHR的学童在支气管扩张前电抗曲线下面积（AX）评分更高，用力肺活量50%时的用力呼气流量（FEF）评分更低，肺清除指数（LCI）2.5%更高。此外，支气管扩张后AX和FEF评分仅部分改善。幼儿期特应性和父母吸烟暴露与学龄期小气道功能障碍无关。
有症状幼儿的AHR与随后持续的小气道功能障碍有关。有必要对更多有症状幼儿样本进行进一步研究，以确定这种关联是否能预测儿童成长过程中哮喘或其他阻塞性肺部疾病的发展。
