背景:通过肺活量测定法将气道阻塞定义为1s内的低用力呼气量(FEV1)与用力肺活量(FVC)之比。这种受损的比率可能源于低FEV1(经典)或正常FEV1与大FVC(沟通障碍)的组合。在普通人群中,儿童期和青春期的沟通障碍的临床意义尚不清楚。
目的:为了研究儿童和青少年时期气道阻塞与低或正常FEV1之间的关系,哮喘,喘息和支气管高反应性(BHR)。
方法:在BAMSE(谷仓/儿童,过敏,Milieu,斯德哥尔摩,流行病学;瑞典)和PIAMA(哮喘和螨过敏的预防和发病率;荷兰)出生队列,梗阻(FEV1:FVC比小于正常下限,LLN)在8岁,12岁(仅PIAMA)或16岁时被归类为经典(FEV1结果:两组中8、12和16岁的典型梗阻患病率为1.5%,1.1%和1.5%,分别。脱垂性梗阻更为普遍:3.9%,2.5%和4.6%,分别。妨碍,无论FEV1如何,都始终与较高的哮喘几率相关(沟通障碍:OR2.29,95%CI1.40至3.74),喘息,哮喘药物使用和BHR与正常肺功能组比较。大约三分之一的儿童期患有沟通障碍的受试者在青春期仍处于沟通障碍状态。
结论:患有气道阻塞的儿童和青少年,不管他们的FEV1水平,哮喘和喘息的患病率较高。这些年龄的随访和治疗应以气道阻塞的存在为指导。
BACKGROUND: Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV1 (classic) or a normal FEV1 in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear.
OBJECTIVE: To investigate the association between airway obstruction with a low or normal FEV1 in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR).
METHODS: In the BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV1:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV1
RESULTS: The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV1, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95% CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence.
CONCLUSIONS: Children and adolescents with airway obstruction had, regardless of their FEV1 level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.