Zhuoran Zhang, Xiaoman Wang, Rui Yuan, Qingjiu Cao
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
J Atten Disord. 2025 Oct;29(12):1092-1106. doi: 10.1177/10870547251349252. Epub 2025 Jun 27.
ADHD often overlaps with pediatric asthma, leading to difficulties in treatment and management in clinical work. Previous research has explored their correlations but gained different conclusions. Thus, this work aims to fill this evidence gap.
Initially, we conducted a cross-sectional study based on data from the National Health and Nutrition Survey (NHANES) 2001 to 2004. The association between ADHD and pediatric asthma was explored by the weighted multivariate-adjusted logistic regression. Then, the bidirectional univariate Mendelian randomization (UVMR) analyses were performed to estimate the causal effects and then investigate if risk factors of pediatric asthma mediated in the causal pathways. Last, we conducted multivariable MR (MVMR) analyses adjusting for these mediating/confounding factors to determine the direct causality between ADHD and pediatric asthma.
In the cross-sectional analysis, ADHD was positively associated with pediatric asthma both before (OR = 1.79, 95% CI [1.26, 2.53], = .008) and after adjusting for all covariates (OR = 1.62, 95% CI [1.10, 2.39], = .048). In the UVMR analysis using the inverse-variance weighting (IVW) method, ADHD was found to increase the risk of pediatric asthma (OR = 1.070, 95% CI [1.029, 1.112], = 6.566 × 10⁻⁴). This association remained significant after adjusting for confirmed mediating factors (obesity traits and smoking exposures) using MVMR (OR = 1.088, 95% CI [1.021, 1.160], = .009). Another adjustment for remaining potential confounders (atopic dermatitis, allergic rhinitis, and inflammatory bowel diseases) via MVMR maintained the significant causal link (OR = 1.272, 95% CI [1.159, 1.396], < .001).
ADHD increased the onset of pediatric asthma with mediating factors including obesity and smoke exposure.
注意力缺陷多动障碍（ADHD）常与小儿哮喘重叠，导致临床工作中的治疗和管理困难。先前的研究探讨了它们之间的相关性，但得出了不同的结论。因此，本研究旨在填补这一证据空白。
首先，我们基于2001年至2004年美国国家健康与营养检查调查（NHANES）的数据进行了一项横断面研究。通过加权多变量调整逻辑回归探讨ADHD与小儿哮喘之间的关联。然后，进行双向单变量孟德尔随机化（UVMR）分析以估计因果效应，并调查小儿哮喘的危险因素是否在因果途径中起中介作用。最后，我们进行多变量MR（MVMR）分析，对这些中介/混杂因素进行调整，以确定ADHD与小儿哮喘之间的直接因果关系。
在横断面分析中，ADHD与小儿哮喘在调整所有协变量之前（OR = 1.79，95% CI [1.26, 2.53]，P = 0.008）和之后（OR = 1.62，95% CI [1.10, 2.39]，P = 0.048）均呈正相关。在使用逆方差加权（IVW）方法的UVMR分析中，发现ADHD会增加小儿哮喘的风险（OR = 1.070，95% CI [1.029, 1.112]，P = 6.566×10⁻⁴）。使用MVMR对已确认的中介因素（肥胖特征和吸烟暴露）进行调整后，这种关联仍然显著（OR = 1.088，95% CI [1.021, 1.160]，P = 0.009）。通过MVMR对其余潜在混杂因素（特应性皮炎、过敏性鼻炎和炎症性肠病）进行的另一项调整维持了显著的因果关系（OR = 1.272，95% CI [1.
