Zeiger Robert S, Schatz Michael, Zhou Botao, Stern Julie A, Li Qiaowu, Stanford Richard H, Shams Marissa, Avella Hernan, Subramaniam Arun, Chen Wansu
Department of Allergy Kaiser Permanente Southern California (KPSC), San Diego, CA, USA; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA; Department of Research and Evaluation, KPSC, Pasadena, CA, USA.
Department of Allergy Kaiser Permanente Southern California (KPSC), San Diego, CA, USA.
J Allergy Clin Immunol Pract. 2025 Jul 31. doi: 10.1016/j.jaip.2025.07.036.
Knowledge of risk factors in early childhood predisposing to moderate-severe persistent asthma (MS-Asthma) in later childhood are needed.
To identify the risk factors for MS-Asthma at 5-11 years in children with early-onset atopic dermatitis (AD).
Electronic health records identified a birth cohort to 11 years of 10,688 children with AD onset between birth and age 36 months. ICD-9/10 coded visits and laboratory data to 36 months were used to detect potential child and maternal risk factors for MS-Asthma. MS-Asthma was defined as GINA-step care level of ≥3 for ≥4 years from ages 5-11 years. Robust Poisson regression determined risk ratios for MS-Asthma.
Compared to children who did not develop MS-Asthma (N=10,168), those developing MS-Asthma (N = 520, 4.9%) from 5-11 years were significantly (P<.01) more likely to be male, of non-Hispanic Black ethnicity, preterm, not-exclusively breast-fed for 1-month, and up to age 3 years have more perinatal respiratory disorders and respiratory infections, food allergy, allergic rhinitis, asthma, allergic sensitizations, and elevated blood eosinophil levels. Mothers of children with MS-Asthma had significantly more comorbidities and antibiotics dispensed, and less pre-existing diabetes (P<.001). Significant adjusted risk factors observed prior to 36 months associated with increased MS-Asthma at 5-11 years included: food allergy; ≥6 AD medication dispensings; nasal corticosteroid dispensing, and number of dispensings of inhaled short-acting beta-agonists, montelukast, and inhaled corticosteroids. Significant protective risk factors were 1-month exclusive breastfeeding and pre-existing maternal diabetes.
Risk models for MS-Asthma in latter childhood were developed based on early childhood and maternal factors using administrative data.
需要了解幼儿期的危险因素，这些因素易导致儿童后期出现中重度持续性哮喘（MS-哮喘）。
确定早发性特应性皮炎（AD）患儿5至11岁时发生MS-哮喘的危险因素。
电子健康记录确定了一个出生队列，其中包括10688名在出生至36个月之间发病的AD患儿，随访至11岁。使用ICD-9/10编码的就诊记录和36个月时的实验室数据来检测MS-哮喘的潜在儿童和母亲危险因素。MS-哮喘定义为5至11岁期间连续4年及以上GINA治疗级别≥3级。稳健泊松回归确定MS-哮喘的风险比。
与未患MS-哮喘的儿童（N = 10168）相比，5至11岁患MS-哮喘的儿童（N = 520，4.9%）更有可能为男性、非西班牙裔黑人、早产、纯母乳喂养不足1个月，并且在3岁之前有更多围产期呼吸系统疾病和呼吸道感染、食物过敏、过敏性鼻炎、哮喘、过敏致敏以及血液嗜酸性粒细胞水平升高。患MS-哮喘儿童的母亲有更多合并症且使用过更多抗生素，且既往糖尿病较少（P <.001）。在36个月之前观察到的与5至11岁时MS-哮喘增加相关的显著调整后危险因素包括：食物过敏；≥6次AD药物配药；鼻用皮质类固醇配药，以及吸入性短效β-激动剂、孟鲁司特和吸入性皮质类固醇的配药次数。显著的保护危险因素是1个月纯母乳喂养和母亲既往糖尿病。
利用管理数据，基于儿童早期和母亲因素建立了儿童后期MS-哮喘的风险模型。
