LeSon S, Gershwin M E
Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine 95616, USA.
J Asthma. 1995;32(4):285-94. doi: 10.3109/02770909509044836.
There are significant concerns regarding the increased mortality of patients with asthma. Indeed the paradox of improved pharmacotherapy but worsening prognosis has been explored in depth in several studies including observations in epidemiology, access to medical care, and drug toxicity. Because of our ability to track all admissions to a tertiary-care hospital, we attempted to define the demographic data from a population of asthmatic children admitted for asthma in order to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions excluding patients with cystic fibrosis. This study included all asthmatics aged 5-12 years admitted over a 10-year period (1984-1994) to the University of California at Davis Medical Center, Sacramento. A total of 300 such asthma admissions were reviewed, involving 135 girls and 165 boys, mean age 7.7 +/- 2.4 years. Of this group, 166 children were black, 70 were Caucasian, 49 were Hispanic, 14 were Asian, and 1 was an American Indian. By National Heart, Lung, and Blood Institute guidelines, this group included 147 mild, 117 moderate, and 36 severe cases. Thirteen children required intubation for their asthma. Significant risk factors identified for children requiring intubation, compared to those who did not require intubation, were secondhand smoke exposure [odds ratio (O.R.) 22.4; 95% confidence interval (C.I.) 7.4, 68.0], psychosocial problems (O.R. 13.5; 95% C.I. 5.1, 36.0), family dysfunction (O.R. 13.0; 95% C.I. 3.9, 43.9), upper respiratory infection (O.R. 10.2; 95% C.I. 3.4, 28.1), little formal education (O.R. 8.7; 95% C.I. 2.4, 31.6), prior asthma emergency room visit in past year (O.R. 7.2; 95% C.I. 1.9, 27.1), prior asthma hospitalization in past year (O.R. 7.1; 95% C.I. 2.2, 22.2), crowding (O.R. 6.9; 95% C.I. 2.5, 19.1), low socioeconomic status (O.R. 6.5; 95% C.I. 2.1, 20.8), steroid-dependent (O.R. 3.8; 95% C.I. 1.2, 12.1), parental history of allergy or asthma (O.R. 3.4; 95% C.I. 1.1, 10.0), and language barrier (O.R. 3.3; 95% C.I. 1.1, 10.6). Nonsignificant mild risk factors included inhaled cromolyn (O.R. 2.7; 95% C.I. 0.7, 10.0), atopy (O.R. 1.9; 95% C.I. 0.6, 5.9), and prior intubation (O.R. 1.6; 95% C.I. 0.2, 13.1). These risk parameters may be important determinants of baseline risk for asthma deaths and their recognition may have a significant impact on preventive measures.
哮喘患者死亡率上升引发了重大担忧。事实上，包括流行病学观察、医疗服务可及性及药物毒性等在内的多项研究已深入探讨了药物治疗改善但预后却恶化这一矛盾现象。由于我们有能力追踪一家三级医疗医院的所有入院病例，我们试图确定因哮喘入院的哮喘儿童群体的人口统计学数据，以找出插管的风险因素。我们对所有哮喘入院病例进行了一项回顾性队列研究，排除了囊性纤维化患者。该研究纳入了1984年至1994年这10年间在萨克拉门托的加利福尼亚大学戴维斯分校医疗中心入院的所有5至12岁哮喘患者。共审查了300例此类哮喘入院病例，涉及135名女孩和165名男孩，平均年龄7.7±2.4岁。在这组患者中，166名儿童为黑人，70名是白种人，49名是西班牙裔，14名是亚洲人，1名是美洲印第安人。根据美国国立心肺血液研究所的指南，该组包括147例轻度、117例中度和36例重度病例。13名儿童因哮喘需要插管。与无需插管的儿童相比，确定的需要插管儿童的显著风险因素包括二手烟暴露[比值比（O.R.）22.4；95%置信区间（C.I.）7.4，68.0]、心理社会问题（O.R. 13.5；95% C.I. 5.1，36.0）、家庭功能障碍（O.R. 13.0；95% C.I. 3.9，43.9）、上呼吸道感染（O.R. 10.2；95% C.I. 3.4，28.1）、正规教育程度低（O.R. 8.7；95% C.I. 2.4，31.6）、过去一年曾因哮喘去过急诊室（O.R. 7.2；95% C.I. 1.9，27.1）、过去一年曾因哮喘住院（O.R. 7.1；95% C.I. 2.2，22.2）、拥挤（O.R. 6.9；95% C.I. 2.5，19.1）、社会经济地位低（O.R. 6.5；95% C.I. 2.1，20.8）、依赖类固醇（O.R. 3.8；95% C.I. 1.2，12.1）、父母有过敏或哮喘病史（O.R. 3.4；95% C.I. 1.1，10.0）以及语言障碍（O.R. 3.3；95% C.I. 1.1，10.6）。不显著的轻度风险因素包括吸入色甘酸钠（O.R. 2.7；95% C.I. 0.7，10.0）、特应性（O.R. 1.9；95% C.I. 0.6，5.9）以及既往插管史（O.R. 1.6；95% C.I. 0.2，13.1）。这些风险参数可能是哮喘死亡基线风险的重要决定因素，对它们的识别可能会对预防措施产生重大影响。
