摘要

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:We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence.
METHODS:Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 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 reassessed annually.
RESULTS:At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P < .001 compared with 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 has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/μL.
CONCLUSIONS:In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.

译文

背景: 与儿童哮喘相关的发病率和死亡率不成比例地由患有严重哮喘的儿童驱动。然而,从纵向研究中还不知道儿童是否会患上严重的哮喘。
目的: 我们试图前瞻性地研究具有良好特征的严重哮喘儿童在青春期是否会超过他们的哮喘。
方法: 用详细的问卷调查、过敏测试和肺功能测试对哮喘儿童进行基线评估,并每年重新评估 3 年。根据美国胸科学会/欧洲呼吸学会指南的评估,重度哮喘儿童的人群得到了丰富,并且每年都对受试者分类进行重新评估。
结果: 基线时,111 (59%) 儿童患有严重哮喘。年复一年,符合严重哮喘标准的比例有所下降。3 年后,只有 30% 的受试者符合严重哮喘的标准 (与入组相比 P <.001)。受试者在大多数严重程度指标上有所改善,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,男孩和女孩同样可能已经解决了哮喘 (33% 比 29%)。对于外周嗜酸性粒细胞计数大于 2.75 个细胞/μ l 的人来说,有利于缓解严重哮喘的比值比为 95% (1.02 CI,7.43-436)。
结论: 在对这一特征良好的队列的纵向分析中,一半患有严重哮喘的儿童在 3 年后不再患有严重哮喘; 符合严重哮喘标准的比例逐步下降。令人惊讶的是,男性和女性受试者的哮喘严重程度同样降低。外周嗜酸性粒细胞增多预测分辨率。这些数据对于规划这一人群的临床试验非常重要。

Severe Asthma

重症 哮喘 疾病
概述  :  

支气管哮喘是一种世界范围内常见的慢性呼吸道疾病。随着全球哮喘防治创议(GINA)的推广,大部分轻至中度哮喘患者经过科学、规范的治疗,可以达到哮喘症状控制的目标。然而部分确诊为哮喘的患者,尽管经过长期规范化治疗,甚至使用大剂量糖皮质激素,症状仍难以控制,同时还要承受使用激素带来的不良反应,这部分患者被称为重症哮喘。这类患者比例约占10%~20%,具有很高的住院率及病死率,发生急性恶性事件风险大,医疗费用高,严重影响患者的生活质量,因而造成巨大的社会负担。 &n

severe 英 [sɪˈvɪə(r)] 美 [sɪˈvɪr]

释义   adj. 严峻的;严厉的;剧烈的;苛刻的

例句   The severe punishment was meted out to the unruly hooligan.对那个不守规矩的流氓进行了严厉的惩罚。

 

asthma 英 [ˈæsmə] 美 [ˈæzmə]

释义   n. [内科][中医] 哮喘,气喘

例句   We have only asthma.我们只有哮喘。

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