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??Abstract??Wheezing in infants is common and the differential diagnosis is broad. For recurrent wheezing?? especially colds and without other causes?? a parental history of asthma?? and physicians diagnosis of eczema or atopic dermatitis?? and eosinophilia will increase the probability of a subsequent asthma diagnosis.Because objective measures of lung function are challenging to perform in infants?? clinical signs and symptoms thus suggest the diagnosis of asthma.     

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??Abstract??Wheezing is common clinical symptoms in early childhood with respiratory diseases.In this paper,epidemidogy,risk factors and trend in development will be described.     

婴幼儿喘息诊治进展

婴幼儿喘息是一种异质性疾病,可分为婴幼儿暂时性喘息、非过敏性持续性喘息和过敏性喘息(即哮喘).婴幼儿暂时性喘息主要与先天性支气管肺发育不良等因素有关,非过敏性持续性喘息主要与病毒感染引起的炎症有关,这一炎症参与的细胞主要是嗜中性粒细胞和淋巴细胞,而哮喘参与的细胞主要是嗜酸性粒细胞.婴幼儿期喘息的发作次数不是诊断哮喘的理想指标,婴幼儿期哮喘的诊断应重视过敏性疾病的遗传背景、个人过敏性疾病史、实验室过敏指标的检查及对支气管扩张剂治疗的反应.在不能明确婴幼儿喘息类型的情况下,联合应用激素、β2肾上腺素能受体激动剂、白三烯受体调节剂和组织胺H1受体阻断剂治疗是一个有效的选择.     

The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children

AIM: This study investigated the influence of early lifestyle factors on the prevalence of asthma and wheezing in preschool children in Tyrol, Austria. METHODS: A cross-sectional questionnaire survey was performed in 1761 preschool children to obtain information on wheezing and asthma in the light of early lifestyle factors. RESULTS: Factors independently associated with an increased risk for wheezing in the past 12 months included high parental education (OR: 1.5, 95% CI: 1.1-2.1) and parental hay fever (OR: 1.5, 95%CI: 1.1-2.2). Risk factors for doctor-diagnosed asthma (DDA) were early pet contact (OR: 2.2, 95% CI: 1.1-4.8) and parental asthma (OR: 3.0, 95%CI: 1.0-9.1), whereas breastfeeding decreased the risk (OR: 0.5, 95% CI: 0.2-1.0). Boiling the pacifier/sucker daily increased the risk for wheezing in the past 12 months (OR: 1.4, 95%CI: 1.0-2.0) and revealed a tendency towards DDA (OR: 1.9, 95% CI: 0.9-4.0). CONCLUSION: In preschool children, we established an independent association between wheezing in the past 12 months, DDA and boiling frequency of the pacifier/bottle sucker during infancy. The impact of pacifier boiling frequency on atopic diseases on the basis of the hygiene hypothesis needs further investigation.     

Immunoglobulin G subclasses in wheezing infants

Background: The wheezing infant is a common but difficult patient to approach diagnostically. The prevalence of immunoglobulin (Ig) G subclass deficiency in wheezing infants is still controversial. Methods: We studied the serum concentration of IgG subclasses in 38 wheezing infants (aged6–24 months) who had not received systemic steroids before investigation and in 30 healthy age matched controls6–31 months). Results: The prevalence of one or more IgG subclass deficiencies was 3 1.6% in wheezing infants and 26.7% in controls. There was no significant difference in prevalence of IgG subclass deficiency between patients and controls (P > 0.05). The mean concentration of IgG subclasses in patients were compared with controls. There was no significant difference in mean serum concentration of IgG₁, G₂ and G₃ subclasses. However, there a trend towards higher concentrations of IgG₄ in wheezing infants and this difference for IgG₅ was significant (P < 0.01). Immunoglobulin G subclass deficiency was found in 25 and 36.4% of wheezing infants who experienced from two to four and five or more wheezing episodes in 2 years, respectively (P > 0.05). Conclusion: Our findings suggest that wheezing in infancy is not associated with IgG subclass deficiency, and in wheezing infants low IgG subclasses levels do not increase the frequency of wheezing. However, is a relationship between recurrent wheezing and serum IgG₄ subclass concentration.     

Sodium cromoglycate therapy in wheezing infants: preliminary evidence of beneficial outcome at early school age

BACKGROUND: In order to affect the natural course of childhood wheezing and asthma, anti-inflammatory therapy is often prescribed for young wheezing children, but there is lack of long-term follow-up data. METHODS: Eighty-two of the original 100 children, hospitalized for wheezing under the age of 2 years in 1992-1993, were re-examined at school age in 1999. The children had participated in an open, randomized, parallel-group trial including a 4-month intervention with inhaled sodium cromoglycate (SCG) or budesonide (BUD). The baseline data, including data on atopy, eosinophilia and viral etiology, were prospectively collected on admission. RESULTS: At early school age (median 7.2 years), asthma was present in 33 (40%) children. There was less asthma in the original SCG (21%) than in the control group (54%) (OR 0.23; 95% CI 0.07-0.77). The figure was 46% in the BUD group. When the analyses were performed separately for atopic and non-atopic infants, the difference was significant only among atopics. The lowered risk for asthma in the SCG group remained significant in the multivariate logistic regression analysis when adjusted for age, sex and atopy, and further when adjusted for earlier episodes of wheezing and respiratory syncytial virus identification. However, after adjustment for blood eosinophilia, the significance was lost, albeit the risk for asthma remained low (OR 0.21; 95% CI 0.04-1.12). A sensitivity analysis, which was done by including the six drop-outs of the SCG group as unfavorable and the 12 drop-outs of other groups as favorable outcomes in the model, did not change the direction of the result (OR 0.70; 95% CI 0.26-1.89). CONCLUSIONS: An early SCG intervention in infants hospitalized for wheezing was associated with a lowered risk for early school-age asthma, especially in infants with evidence of atopy.     

Cytomegalovirus infection and wheezing in infants

Background: Bronchial asthma‐like symptoms such as wheezing are commonly associated with respiratory tract infection including respiratory syncytial virus (RSV) infection in infants. No study on the association of wheezing with cytomegalovirus (CMV) infection in infancy has been reported, although CMV infection has been observed to play some role in prolonged and intractable wheezing in limited cases. Methods: The present study investigated 40 hospitalized infants who presented with first‐episode wheezing between October 2003 and September 2004. Nasopharyngeal aspirates were tested for RSV, and serum antibodies against CMV were measured. As controls, age‐matched infants with no wheezing were examined for CMV serostatus. Results: RSV‐antigen was detected in 21 subjects (53%), and seven (18%) were considered primary CMV infection serologically. Primary CMV infection was found more often in the wheezers than in the controls although the difference was not statistically significant (P = 0.06). The incidence of splenomegaly was significantly higher in wheezers with CMV infection (86%) than in those with RSV infection or without either infection. The duration of wheezing, fever, and radiographic and laboratory findings during hospitalization were not significantly different. Conclusions: CMV infection based on serologic diagnosis should be considered in infants with first wheezing episode and particularly those with splenomegaly.     

婴幼儿反复、持续吼喘58例病因分析

目的提高临床儿科医师对婴幼儿反复吼喘的鉴别诊断能力。方法对临床持续吼喘≥4周或反复吼喘≥3次、年龄≤3岁的58例住院患儿进行病因分析。结果58例中诊断为婴幼儿哮喘26例,气管、支气管软化10例,气管、支气管狭窄9例,异物4例,支气管肺发育不良2例,胃食管返流4例,其他原因3例。结论婴幼儿出现反复吼喘最多见原因为婴幼儿哮喘;小婴儿必须排除先天性因素的可能性,6个月以内的小婴儿持续或反复吼喘最多见原因为先天性气道或肺发育异常疾病。     

Asthma symptoms in early childhood – what happens then?

Aim: To study the outcome in early adulthood for children with early asthma symptoms and to analyse the factors associated with current asthma. Methods: In a prospective study, we have re-investigated 89/101 children who were hospitalized before the age of two years due to wheezing. The children were investigated using a questionnaire and allergy and bronchial hyper-responsiveness tests at the age of 17-20 years and compared with age-matched controls. Results: In the cohort, 43% had had asthma symptoms in the preceding 12 months compared with 15% in the control group. The strongest risk factors for asthma were current allergy, bronchial hyper-responsiveness and female gender. Female gender and passive smoking in infancy were independent infantile risk factors. In addition to female gender, two pathways led to current asthma: an allergic pathway from family atopy via the development of allergy and another pathway from early passive smoking via hyper-responsiveness and active smoking.

Conclusion: In children with early wheezing disorder, current allergy, bronchial hyper-responsiveness and female gender were the strongest risk factors for asthma in early adulthood, while female gender and passive smoking in infancy were independent infantile risk factors. The effects of early passive smoking persist longer than previously reported.     

婴幼儿喘息与呼吸道病毒感染及过敏的关系

目的探讨婴幼儿喘息与呼吸道病毒感染及过敏的关系。方法选择反复喘息(哮喘和喘息性支气管炎)患儿152例、毛细支气管炎(毛支)患儿191例、肺炎患儿101例,取鼻咽分泌物进行7种常见呼吸道病毒检测,同时取血筛查过敏原。结果3组患儿病毒检测总阳性率为60.4%,各组患儿病毒检测阳性率差异有显著性(P<0.01),但均以呼吸道合胞病毒(RSV)为主,其他病毒阳性率很低。所有患儿食物过敏阳性率为25.5%,吸入过敏原阳性率仅5.6%。3组患儿的过敏原阳性率差异有显著性(P<0.05或0.01),反复喘息组显著高于毛支组和肺炎组(P均<0.05),而后两组间差异无显著性。结论RSV是诱发婴幼儿喘息和喘息反复发作的主要病原;过敏是婴幼儿反复喘息发生的重要危险因素,而呼吸道合胞病毒感染的发生与患儿是否存在过敏无关。     

上海市普陀区儿童喘息及哮喘流行病学调查

目的了解上海市普陀区儿童喘息和哮喘的患病状况,以及控制和治疗情况。方法整群随机抽样法抽取在普陀区10所社区卫生服务中心健康体检的婴幼儿和12所幼儿园的学龄前期儿童、3所小学及8所中学的学龄期和青春期儿童;对这些儿童和(或)其父母进行问卷调查。结果共调查11 771名儿童,其中男5 832名,女5 939名。在全体被调查者中,917名(占7.79%)有喘息或哮喘史,男性占9.34%、女性6.26%;喘息或哮喘现患率为4.21%,男性4.94%,女性3.40%,性别差异有统计学意义(P均<0.01)。无论是喘息或哮喘史,还是喘息或哮喘的现患率,均高于2000年上海市调查结果(4.52%,3.34%),差异有统计学意义(χ2=122.5、13.76,P均<0.01)。在>7岁有喘息或哮喘史的儿童中,第一次喘息发作年龄≤3岁者占55.94%。在喘息或哮喘现患儿童中,长期规范吸入糖皮质激素治疗者仅占13.51%。结论上海市普陀区,目前有喘息或哮喘史及喘息或哮喘现患率儿童的比例较2000年增加,儿童第一次喘息发作年龄小,哮喘儿童的长期规范治疗差。     

Wheezing requiring hospitalization in early childhood: Predictive factors for asthma in a six-year follow-up

Although asthma is common after wheezing in early childhood, the risk factors for and the prevention of later asthma are poorly understood. During the present follow-up study, a range of possible predictive factors for school-age asthma was evaluated. The study group consisted of 82 children hospitalized for wheezing at age < 2 years in 1992–93. The baseline data were collected on entry to the study. In 1999, the children were re-examined at the median age of 7.2 years. A structured questionnaire was applied to chart the symptoms suggestive of asthma, and the children were examined clinically. An exercise challenge test, as well as skin prick tests (SPT) to common inhalant allergens, was performed. Asthma was present in 33 (40%) children, 30 (91%) having continuous medication for asthma. The significant asthma-predictive factors, present on entry to the study, were blood eosinophilia (p = 0.0008), atopic dermatitis (p = 0.0089), elevated total serum immunoglobulin E (IgE) (p = 0.0452), and a history of earlier episodes of wheezing in infancy (p = 0.0468). SPT positivity in early childhood was also associated with school-age asthma (p = 0.002). In contrast, respiratory syncytial virus (RSV) identification during the index episode of wheezing played a minor role as a predictive factor for asthma. In conclusion, if hospitalization for wheezing occurs in infancy, more than every third child will suffer from asthma at early school age; the risk is significantly increased with recurrent wheezing in infancy and the development of allergic manifestations.     

喘息婴幼儿鼻咽分泌物嗜酸粒细胞与血清特异性IgE的关系分析

目的 探讨婴幼儿喘息时鼻咽分泌物涂片中嗜酸粒细胞计数及与血清特异性IgE的关系.方法 选择2002-2004年收治的1个月～3岁的喘息及支气管肺炎患儿223例,分为3组,其中反复喘息(包括婴幼儿哮喘和喘息发作≥2次)组76例,毛细支气管炎组65例,支气管肺炎(无喘息症状)组82例.吸取鼻咽分泌物1ml进行嗜酸粒细胞计数,并测定血清特异性IgE的水平.结果 反复喘息组鼻咽分泌物嗜酸粒细胞计数明显高于其他两组,差异有统计学意义(P=0.000);反复喘息组血清食物变应原(fx5E)的阳性检出率及吸入性变应原(Phadiatop)阳性检出率均明显高于其他两组,差异有统计学意义(P=0.000),毛支组和支气管肺炎组之间差异则无统计学意义;血清特异性IgE与鼻咽分泌物嗜酸粒细胞计数之间存在显著正相关;鼻咽分泌物嗜酸粒细胞水平在同时存在喘息和特应性的患儿最高,在既没有喘息也无个人特应性的患儿最低,有喘息或血清IgE一项者介于两组之间.结论 鼻咽分泌物嗜酸粒细胞计数方法操作简单、无创、快速,费用低,且能在一定程度上反映哮喘的病理特征,与血清特异性IgE之间呈正相关,可以在临床进一步推广应用.     

Efficacy of prednisolone in children hospitalized for recurrent wheezing

Data on the efficacy of corticosteroids on respiratory picornavirus-induced wheezing are limited. To determine whether prednisolone is effective in rhinovirus- or enterovirus-induced recurrent wheezing, we conducted a controlled trial comparing oral prednisolone (2 mg/kg/day in three divided doses for 3 days) with placebo in hospitalized wheezing children and studied post hoc virus-specific efficacy in early wheezing (<3 episodes, reported elsewhere) and in recurrent wheezing (>or=3 episodes). Virus-negative children where excluded. Our primary endpoint was the time until children were ready for discharge. Secondary endpoints included oxygen saturation and exhaled nitric oxide during hospitalization, duration of symptoms, blood eosinophil count, and impulse oscillometry 2 wk after discharge, and occurrence of relapses during the following 2 months. Virus-specific effects were analyzed with interaction analysis in a multivariate regression model. During the study period, 661 patients were hospitalized, 293 randomized, and 59 were accepted in this analysis (mean age 2.6 yr, s.d. 1.3). Prednisolone did not significantly decrease the time until ready for discharge in all patients (prednisolone vs. placebo, medians, 18 vs. 24 h, p = 0.11). However, prednisolone decreased the time until ready for discharge in children with picornavirus infection (respectively, 12 vs. 24 h, p = 0.0022) and more specifically, in children with enterovirus infection (6 vs. 35 h, p = 0.0007). In the secondary endpoints, prednisolone decreased the duration of cough and dyspnea in rhinovirus-affected children (p = 0.033 for both). Prospectively designed clinical trial is needed to test the hypothesis that prednisolone reduces symptoms in picornavirus-affected wheezing children.