一项儿童和青少年严重哮喘的纵向研究
2019/11/12
摘要
背景：与儿童哮喘相关的发病率和死亡率主要由重症哮喘儿童引起。然而，纵向研究中儿童是否能摆脱重症哮喘还是未知。
目的：前瞻性研究临床特征良好的重症哮喘儿童是否在青春期仍发展为重症哮喘。
方法：详细问卷调查、过敏试验和肺功能检测对哮喘患儿进行基线检查，每年复查一次，为期3年。根据美国胸科学会/欧洲呼吸学会指南的评估，重症哮喘儿童的人群更为丰富，每年重新评估受试者分类。
结果：在基线检查时，111名儿童（59%）患有重症哮喘。与去年同期相比，符合重症哮喘标准的比例有所下降。三年后，只有30%的受试者符合重症哮喘的标准（与入组相比p<0.001）。受试者在大多数严重程度指标上都有改善，包括症状评分、病情恶化和控制者用药要求，但肺功能没有改善。令人惊讶的是，男孩和女孩缓解率相似（33%对29%）。外周嗜酸性粒细胞计数超过436细胞/μl者，有利于缓解严重哮喘的优势比为2.75（CI 1.02-7.43）。
结论：在这一临床特征良好的队列的纵向分析中，有一半重症哮喘儿童在3年后不再为重症哮喘；符合重症哮喘标准的患儿比例逐步下降。令人惊讶的是，哮喘的严重程度在男性和女性中下降率相同。外周嗜酸性粒细胞增多症可预测重症哮喘缓解。这些数据对于在这些人群中规划临床试验将有重要意义。
Severe asthma during childhood and adolescence: A longitudinal study.
Ross KR, Gupta R, DeBoer MD, Zein J, Phillips BR, Mauger DT, Li C, Myers RE, Phipatanakul W, Fitzpatrick AM, Ly NP, Bacharier LB, Jackson DJ, Celedón JC, Larkin A, Israel E, Levy B, Fahy JV, Castro M, Bleecker ER, Meyers D, Moore WC, Wenzel SE, Jarjour NN, Erzurum SC, Teague WG, Gaston B.
Abstract
BACKGROUND: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma.
OBJECTIVE: To study prospectively whether well-characterized children with severe asthma outgrow severe asthma during adolescence.
METHODS: Children with asthma were assessed at baseline with detailed questionnaires, allergy testing and lung function testing and were re-assessed annually for three years. The population was enriched for children with severe asthma as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was re-assessed annually.
RESULTS: At baseline, 111 children (59%) had severe asthma. Year over year, there was a decrease in the proportion meeting criteria for severe asthma. After three years, only 30% of subjects met criteria for severe asthma (p<0.001 compared to enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to resolve (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (CI 1.02-7.43) for those with a peripheral eosinophil count over 436 cells/μL.
CONCLUSIONS: In longitudinal analysis of this well-characterized cohort, half of children with severe asthma were no longer severe after three years; there was a stepwise decline in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in males and females. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.
背景：与儿童哮喘相关的发病率和死亡率主要由重症哮喘儿童引起。然而，纵向研究中儿童是否能摆脱重症哮喘还是未知。
目的：前瞻性研究临床特征良好的重症哮喘儿童是否在青春期仍发展为重症哮喘。
方法：详细问卷调查、过敏试验和肺功能检测对哮喘患儿进行基线检查，每年复查一次，为期3年。根据美国胸科学会/欧洲呼吸学会指南的评估，重症哮喘儿童的人群更为丰富，每年重新评估受试者分类。
结果：在基线检查时，111名儿童（59%）患有重症哮喘。与去年同期相比，符合重症哮喘标准的比例有所下降。三年后，只有30%的受试者符合重症哮喘的标准（与入组相比p<0.001）。受试者在大多数严重程度指标上都有改善，包括症状评分、病情恶化和控制者用药要求，但肺功能没有改善。令人惊讶的是，男孩和女孩缓解率相似（33%对29%）。外周嗜酸性粒细胞计数超过436细胞/μl者，有利于缓解严重哮喘的优势比为2.75（CI 1.02-7.43）。
结论：在这一临床特征良好的队列的纵向分析中，有一半重症哮喘儿童在3年后不再为重症哮喘；符合重症哮喘标准的患儿比例逐步下降。令人惊讶的是，哮喘的严重程度在男性和女性中下降率相同。外周嗜酸性粒细胞增多症可预测重症哮喘缓解。这些数据对于在这些人群中规划临床试验将有重要意义。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2019 Oct 14. pii: S0091-6749(19)31318-1. doi: 10.1016/j.jaci.2019.09.030.)
(J Allergy Clin Immunol. 2019 Oct 14. pii: S0091-6749(19)31318-1. doi: 10.1016/j.jaci.2019.09.030.)
Severe asthma during childhood and adolescence: A longitudinal study.
Ross KR, Gupta R, DeBoer MD, Zein J, Phillips BR, Mauger DT, Li C, Myers RE, Phipatanakul W, Fitzpatrick AM, Ly NP, Bacharier LB, Jackson DJ, Celedón JC, Larkin A, Israel E, Levy B, Fahy JV, Castro M, Bleecker ER, Meyers D, Moore WC, Wenzel SE, Jarjour NN, Erzurum SC, Teague WG, Gaston B.
Abstract
BACKGROUND: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma.
OBJECTIVE: To study prospectively whether well-characterized children with severe asthma outgrow severe asthma during adolescence.
METHODS: Children with asthma were assessed at baseline with detailed questionnaires, allergy testing and lung function testing and were re-assessed annually for three years. The population was enriched for children with severe asthma as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was re-assessed annually.
RESULTS: At baseline, 111 children (59%) had severe asthma. Year over year, there was a decrease in the proportion meeting criteria for severe asthma. After three years, only 30% of subjects met criteria for severe asthma (p<0.001 compared to enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to resolve (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (CI 1.02-7.43) for those with a peripheral eosinophil count over 436 cells/μL.
CONCLUSIONS: In longitudinal analysis of this well-characterized cohort, half of children with severe asthma were no longer severe after three years; there was a stepwise decline in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in males and females. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.
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成人哮喘与情感特征：一项遗传信息研究
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临床与家庭使用奥马利珠单抗和美泊利单抗的健康和经济效益评估对比
