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Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma

Michael J. McGeachie ... 呼吸系统疾病 妇产科和儿科 • 2016.05.12
• 增加吸入性糖皮质激素以预防哮喘发作 • 每日或间歇性布地奈德治疗学龄前儿童复发性哮鸣 • 环境微生物暴露与儿童哮喘






研究者以患者童年期到成年期的肺量测定结果为依据,即第一秒用力呼气量(FEV1)曲线图,将肺功能的发育及衰退划分为四种特征性模式,并以此对小儿哮喘患者分类,并检查异常模式的相关风险因素。以美国国家健康与营养调查研究(National Health and Nutrition Examination Survey)中非哮喘研究参与者的FEV1值作为正常值。



在684例研究参与者中,170例(25%)研究参与者肺功能发育正常且无早期衰退,514例(75%)研究参与者肺功能发育异常。肺功能发育异常的研究参与者中,176例(26%)研究参与者肺功能发育不足且早期衰退,160例(23%)仅发育不足,178例(26%)发育正常但早期衰退。肺功能发育不足与下列情况相关:FEV1基线值较低、支气管扩张剂反应较小、基线时气道高反应性以及性别男(针对各因素进行对比,均P<0.001)。最后一次肺量测定中(均值[±SD]年龄,26.0岁±1.8岁),73例研究参与者(11%)达到《慢性阻塞性肺病全球倡议》(Global Initiative for Chronic Obstructive Lung Disease)所述的肺功能障碍标准,呈慢性阻塞性肺疾病(COPD)表现,这些研究参与者更易发生肺功能发育不足,而非正常发育(8%对3%,P<0.001)。



对于肺功能发育和衰退的纵向模式异常,最重要的预测指标包括儿童期肺功能受损和性别男。持续性哮喘且肺功能发育不足的患儿,其成年早期发生固定气流阻塞的风险增大,并可能患COPD(由Parker B. Francis基金会等资助;ClinicalTrials.gov注册号为NCT00000575)。


Michael J. McGeachie, Ph.D., Katherine P. Yates, Sc.M., Xiaobo Zhou, Ph.D., Feng Guo, Ph.D., Alice L. Sternberg, Sc.M., Mark L. Van Natta, M.H.S., Robert A. Wise, M.D., Stanley J. Szefler, M.D., Sunita Sharma, M.D., Alvin T. Kho, Ph.D., Michael H. Cho, M.D., Damien C. Croteau-Chonka, Ph.D., Peter J. Castaldi, M.D., Gaurav Jain, M.S., Amartya Sanyal, Ph.D., Ye Zhan, Bryan R. Lajoie, Ph.D., Job Dekker, Ph.D., John Stamatoyannopoulos, M.D., Ronina A. Covar, M.D., Robert S. Zeiger, M.D., Ph.D., N. Franklin Adkinson, M.D., Paul V. Williams, M.D., H. William Kelly, Pharm.D., Hartmut Grasemann, M.D., Judith M. Vonk, Ph.D., Gerard H. Koppelman, M.D., Dirkje S. Postma, M.D., Benjamin A. Raby, M.D., Isaac Houston, Ph.D., Quan Lu, Ph.D., Anne L. Fuhlbrigge, M.D., Kelan G. Tantisira, M.D., Edwin K. Silverman, M.D., Ph.D., James Tonascia, Ph.D., Scott T. Weiss, M.D., and Robert C. Strunk, M.D., for the CAMP Research Group*
From the Channing Division of Network Medicine and the Department of Medicine (M.J.M., X.Z., F.G., A.T.K., M.H.C., D.C.C.-C., P.J.C., B.A.R., I.H., A.L.F., K.G.T., E.K.S., S.T.W.) and the Division of Pulmonary and Critical Care Medicine (A.L.F.), Brigham and Women’s Hospital, Boston Children’s Hospital (A.T.K.), and the Program in Molecular and Integrative Physiological Sciences, Departments of Environmental Health and Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health (Q.L.), Boston; Johns Hopkins Bloomberg School of Public Health (K.P.Y., A.L.S., M.L.V.N., J.T.) and Johns Hopkins University School of Medicine (R.A.W., N.F.A.), Baltimore; National Jewish Health, Children’s Hospital Colorado, and University of Colorado Denver School of Medicine (S.J.S., R.A.C.), Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado (S.S.), and University of Colorado (R.A.C.), Denver; Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology (G.J., A.S., Y.Z., B.R.L., J.D.), and Howard Hughes Medical Institute (J.D.), University of Massachusetts Medical School, Worcester; School of Biological Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (A.S.); Genome Sciences, School of Medicine, University of Washington (J.S.), and ASTHMA Inc. Clinical Research Center and Northwest Asthma and Allergy Center (P.V.W.), Seattle; University of California at San Diego, Pediatrics, La Jolla, and Kaiser Permanente Southern California Region, San Diego (R.S.Z.); University of New Mexico Health Sciences Center, Albuquerque (H.W.K.); the Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children and University of Toronto, Toronto (H.G.); Groningen Research Institute for Asthma and COPD (J.M.V., G.H.K., D.S.P.), the Departments of Epidemiology (J.M.V.) and Pulmonology (D.S.P.), University of Groningen, University Medical Center Groningen, and the Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital (G.H.K.), Groningen, the Netherlands; and the Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis (R.C.S.).Address reprint requests to Dr. Weiss at Channing Laboratory, 181 Longwood Ave., Rm. 459, Boston, MA 02115, or at scott.weiss@channing.harvard.edu. *A complete list of members of the Childhood Asthma Management Program (CAMP) Research Group is provided in Supplementary Appendix 1, available at NEJM.org.



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