Korppi M, Kuikka L, Reijonen T, Remes K, Juntunen-Backman K, Launiala K
Department of Pediatrics, Kuopio (Finland) University Hospital.
Arch Pediatr Adolesc Med. 1994 Oct;148(10):1079-84. doi: 10.1001/archpedi.1994.02170100077015.
To determine the infantile risk factors and long-term outcome up to 8 to 10 years of age for bronchial asthma and hyperreactivity in children with early-childhood bronchiolitis or pneumonia.
Prospective follow-up of three groups of children.
University hospital providing primary hospital care and outpatient consultations for all pediatric patients in a defined area.
None.
The study groups consisted of 62 children with early-childhood bronchiolitis, 29 children with early-childhood pneumonia with no wheezing, and 52 control children.
Infantile risk factors were prospectively registered until 2 years of age. Clinical examination, performed 7 to 8 years later, included recording of atopic and asthmatic symptoms from the preceding 12 months. The methacholine inhalation challenge test was used to assess bronchial hyperreactivity, and mean midexpiratory flow results were used to assess bronchial obstruction.
Bronchial asthma was present in nine (15%) of the 62 children from the bronchiolitis group, compared with 7% in the pneumonia group and 2% in the control group. Bronchial hyperreactivity indicated by methacholine inhalation challenge was far more common; it was present in 62% of the bronchiolitis group and in 45% of the pneumonia group. Both groups differed significantly from the control group. Decreased mean midexpiratory flow values were observed in 29% and 21% of the bronchiolitis and pneumonia groups, respectively. All 10 asthmatic patients had bronchial hyperreactivity, but only 20% of hyperreactive children had asthma. An analysis of infantile risk factors disclosed only one, an early onset of wheezing, with a significant effect on bronchial hyperreactivity at school age. Elevated IgE values measured during infancy were associated with the development of clinical asthma.
The risk of bronchial asthma was increased after infantile bronchiolitis. Moreover, bronchial hyperreactivity was increased after both infantile bronchiolitis and pneumonia. Methacholine inhalation challenge was a sensitive but nonspecific test for diagnosing bronchial asthma. Both bronchiolitis and pneumonia resulting in hospitalization in early childhood distinguish a group of children with an increased risk for long-term lung function abnormalities and pulmonary illnesses.
确定患有幼儿期细支气管炎或肺炎的儿童支气管哮喘和高反应性的婴幼儿期危险因素及8至10岁的长期预后。
对三组儿童进行前瞻性随访。
为特定区域内所有儿科患者提供初级医院护理和门诊咨询的大学医院。
无。
研究组包括62名患有幼儿期细支气管炎的儿童、29名无喘息的幼儿期肺炎儿童和52名对照儿童。
前瞻性记录婴幼儿期危险因素直至2岁。在7至8年后进行临床检查，包括记录前12个月的特应性和哮喘症状。使用乙酰甲胆碱吸入激发试验评估支气管高反应性，使用平均呼气中期流速结果评估支气管阻塞。
细支气管炎组62名儿童中有9名（15%）患有支气管哮喘，肺炎组为7%，对照组为2%。乙酰甲胆碱吸入激发试验显示的支气管高反应性更为常见；细支气管炎组中62%存在，肺炎组中45%存在。两组与对照组均有显著差异。细支气管炎组和肺炎组分别有29%和21%的患者平均呼气中期流速值降低。所有10名哮喘患者均有支气管高反应性，但只有20%的高反应性儿童患有哮喘。对婴幼儿期危险因素的分析仅发现一个因素，即喘息早发，对学龄期支气管高反应性有显著影响。婴儿期测得的IgE值升高与临床哮喘的发生有关。
婴幼儿期细支气管炎后支气管哮喘风险增加。此外，婴幼儿期细支气管炎和肺炎后支气管高反应性均增加。乙酰甲胆碱吸入激发试验是诊断支气管哮喘的敏感但非特异性试验。导致幼儿期住院的细支气管炎和肺炎均使一组儿童长期肺功能异常和肺部疾病风险增加。
