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学龄前儿童的超重/肥胖(OW)与哮喘恶化相关,但吸入糖皮质激素能显著改善症状

2018/01/08

   摘要
   背景: 既往研究表明,超重/肥胖在年龄稍大的儿童及成年患者中与哮喘恶化及吸入糖皮质激素(ICS)治疗反应不佳相关。
   目的: 本研究目的在于描述学龄前儿童OW与哮喘严重程度及ICS治疗反应性之间的关系。
   方法:这是一项针对纳入2-5岁的学龄前儿童为研究对象的3项大型多中心临床试验的事后研究。研究中比较了正常体重(NW)(体重指数:第10-84百分位数)与OW(体重指数:≥ 第85百分位)儿童年平均哮喘症状天数及急性加重的比率。研究对象被随机分为规律每日ICS治疗组,间歇ICS治疗组或每日安慰剂治疗组。 使用单一多变量线性回归来比较组间差异。
   结果:在未接受日常治疗的患儿中,OW儿童发作哮喘(90.7 vs 53.2,P = 0.020)和急性加重(1.4 vs 0.8,P = 0.009)比例较NW儿童高。 在ICS治疗组中,OW和NW儿童发作哮喘(规律吸入ICS治疗: 47.2vs44.0天,P = 0.44;间歇ICS治疗:61.8vs52.9天,P = 0.46;根据需要ICS治疗: 53.3 vs 47.3 days, P = 0.53 )和急性加重的比例(规律吸入ICS治疗: 0.6 vs 0.8,P =0 .10;短期ICS治疗: 1.1 vs 0.8 d,P = 0.25;根据需要ICS治疗: 1.0 vs 1.1, P = 0.72)类似。与安慰剂相比,规律吸入ICS治疗能明显减少OW患者年平均哮喘症状天数(90.7 vs 41.2,P = .004)和恶化比例(1.4 vs 0.6,P = 0.006),而在NW患者中没有观察到类似的保护效果。
   结论:在未接受控制性治疗的学龄前儿童中,OW与哮喘控制不佳及急性发作相关。 然而,与相对年长的哮喘患者不同的是,学龄前的OW儿童对ICS治疗的反应性并不差。

 
(中日友好医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2017 Dec 8. pii: S0091-6749(17)31738-4.)

 
 
 
Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids.
 
Lang JE, Fitzpatrick AM,Mauger DT, Guilbert TW, Jackson DJ, Lemanske RF Jr, Martinez FD, Strunk RC, Zeiger RS, Phipatanakul W,Bacharier LB, Pongracic JA, Holguin F, Cabana MD, Covar RA, Raissy HH, Tang M, Szefler SJ

Abstract
BACKGROUND:Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults.
OBJECTIVE:We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children.
METHODS:This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups.
RESULTS:Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P = .020) and exacerbations (1.4 vs 0.8, P = .009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthmasymptom days (daily ICS: 47.2 vs 44.0 days, P = .44; short-term ICS: 61.8 vs 52.9 days, P = .46; as-needed ICS: 53.3 vs 47.3 days, P = .53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P = .10; short-term ICS: 1.1 vs 0.8 days, P = .25; as-needed ICS: 1.0 vs 1.1, P = .72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P = .004) and exacerbations (1.4 vs 0.6, P = .006), while similar protective ICS effects were less apparent among NW.
CONCLUSIONS:In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.
 


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