哮喘联盟

   摘要
   背景：青春期是一个变化的时期，这与大比例儿童期哮喘患者的疾病缓解一致。目前对不同青春期哮喘转变的根本特征变化还不完全认识。本研究旨在通过纵向出生队列研究探讨青少年哮喘表型转变的病理生理学特征。
   方法：在1、2、4、10和18岁时分别评估怀特岛出生队列（N = 1456）。特征描述包括问卷调查、皮肤点刺试验、呼吸量测定、呼出气一氧化氮、支气管激发试验（在100例18岁的子集中）和诱导痰。分为4组： “非哮喘组”（自出生无哮喘）、“持续性哮喘组”（10岁和18岁时均患有哮喘）、“哮喘缓解组”（10岁时患有哮喘，但在18岁时无哮喘）和“青春期发作哮喘组”（10岁时无哮喘，但在18岁时患有哮喘）。
   结果：与18岁持续性哮喘组患者相比，哮喘缓解组患者在10岁时具有更低的支气管反应性（优势比OR为0.30；Cl为0.10－0.90；p = 0.03），显著改善肺功能（用力呼气量25%－75%增加：1.7L；区间为1.0-2.9；p = 0.04）。与持续性哮喘相比，男性（OR为0.3；Cl为0.1-0.7；p < 0.01）和较少对乙酰氨基酚的使用（OR为0.4；Cl为0.2-0.8；p < 0.01）均为哮喘缓解的独立因素。与非哮喘组相比，哮喘缓解组具有更低的痰液细胞总数（31.5，25%-75%区间12.9-40.4 vs. 47.0，25%-75%区间19.5-181.3；p = 0.03）。青春期发作哮喘组痰检显示有嗜酸粒细胞性气道炎症（3.0%，0.7-6.6），在持续性哮喘组中则没有（1.0%, 0-3.9），哮喘缓解组痰液嗜酸性粒细胞计数最低（0.3%, 0-1.4），且嗜酸性粒细胞/中性粒细胞的比率最低为0（四分位间距：0.1）。
   结论：青春期哮喘缓解组与其初始的气道高反应性较低和小气道功能有更大的改善存在相关性，而青春期发作哮喘组主要表现为嗜酸性粒细胞气道炎症。
 

（苏楠 审校）
Respir Res. 2014 Nov 29;15(1):153. doi: 10.1186/s12931-014-0153-7.


 

Pathophysiological characterization of asthma transitions across adolescence.
 

Arshad SH1, Raza A, Lau L, Bawakid K, Karmaus W, Zhang H, Ewart S, Patil V, Roberts G, Kurukulaaratchy R.
 

ABSTRACT
BACKGROUND: Adolescence is a period of change, which coincides with disease remission in a significant proportion of subjects with childhood asthma. There is incomplete understanding of the changing characteristics underlying different adolescent asthma transitions. We undertook pathophysiological characterization of transitional adolescent asthma phenotypes in a longitudinal birth cohort.
METHODS: The Isle of Wight Birth Cohort (N = 1456) was reviewed at 1, 2, 4, 10 and 18-years. Characterization included questionnaires, skin tests, spirometry, exhaled nitric oxide, bronchial challenge and (in a subset of 100 at 18-years) induced sputum. Asthma groups were "never asthma" (no asthma since birth), "persistent asthma" (asthma at age 10 and 18), "remission asthma" (asthma at age 10 but not at 18) and "adolescent-onset asthma" (asthma at age 18 but not at age 10).
RESULTS: Participants whose asthma remitted during adolescence had lower bronchial reactivity (odds ratio (OR) 0.30; CI 0.10 -0.90; p = 0.03) at age 10 plus greater improvement in lung function (forced expiratory flow 25-75% gain: 1.7 L; 1.0-2.9; p = 0.04) compared to persistent asthma by age 18. Male sex (0.3; 0.1-0.7; p < 0.01) and lower acetaminophen use (0.4; 0.2-0.8; p < 0.01) independently favoured asthma remission, when compared to persistent asthma. Asthma remission had a lower total sputum cell count compared to never asthma (31.5 [25-75 centiles] 12.9-40.4) vs. 47.0 (19.5-181.3); p = 0.03). Sputum examination in adolescent-onset asthma showed eosinophilic airway inflammation (3.0%, 0.7-6.6), not seen in persistent asthma (1.0%, 0-3.9), while remission group had the lowest sputum eosinophil count (0.3%, 0-1.4) and lowest eosinophils/neutrophils ratio of 0.0 (Interquartile range: 0.1).
CONCLUSION: Asthma remission during adolescence is associated with lower initial BHR and greater gain in small airways function, while adolescent-onset asthma is primarily eosinophilic.
 

Respir Res. 2014 Nov 29;15(1):153. doi: 10.1186/s12931-014-0153-7.