Gani F, Landi M, Ricca V, Senna G, Mezzelani P
Clinica Malattie Apparato Respiratorio, Ospedale San Luigi Gonzaga, Torino.
Recenti Prog Med. 1998 Dec;89(12):668-73.
Asthma is a chronic inflammatory disease of airways with a multifactorial pathogenesis. Both genetic and environmental factors contribute to the development of the disease which can vary in the same patient through time. Due to its complexity, natural history of asthma is poorly well-known. Generally, in the history of asthma three periods of life are taken into consideration: early childhood, adolescence and adult life. It has been demonstrated that less than one third of children who are affected by wheezing in early childhood develop a true asthma afterwards. Usually in these subjects who are male and atopic, viruses and subsequently allergens represent the most important factors responsible for the development of asthma. During adolescence airborne allergens represent the main cause of the disease: mites in infancy and pollens in late childhood. The incidence of asthma during adolescence is growing according to recent studies, and even if the symptomatology of asthma improves through time, about two thirds of patients remain asthmatic in their adult life. As regards adults etiology, it is less known, women are more frequently affected than men and the prognosis is generally poorer. Several factors negatively influence the course of asthma such as age, smoking, the severity of the disease during infancy, the persistence of functional obstructive alterations and the increased aspecific bronchial reactivity. Adequate therapy is crucially important to cope with these factors and can change the course of the disease.
哮喘是一种气道慢性炎症性疾病，发病机制具有多因素性。遗传和环境因素均对该疾病的发展起作用，且在同一患者中，其病情会随时间变化。由于其复杂性，哮喘的自然病史鲜为人知。一般来说，在哮喘病史中会考虑人生的三个阶段：幼儿期、青春期和成年期。已证实，幼儿期出现喘息的儿童中，不到三分之一之后会发展为真正的哮喘。通常在这些男性且具有特应性的受试者中，病毒以及随后的过敏原是导致哮喘发展的最重要因素。在青春期，空气传播的过敏原是该疾病的主要病因：婴儿期是螨虫，儿童后期是花粉。根据最近的研究，青春期哮喘的发病率在上升，并且即使哮喘症状会随时间改善，但约三分之二的患者在成年后仍患有哮喘。至于成人的病因，了解较少，女性比男性更易受影响，且总体预后较差。一些因素会对哮喘病程产生负面影响，如年龄、吸烟、婴儿期疾病的严重程度、功能性阻塞性改变的持续存在以及非特异性支气管反应性增加。充分的治疗对于应对这些因素至关重要，并且可以改变疾病的进程。
