毛细支气管炎患儿发展为哮喘的相关因素分析

目的：探讨毛细支气管炎患儿可能发展为哮喘的相关因素。方法：对108例毛细支气管炎患儿随访3年。对患儿性别、出生时母亲年龄、父亲吸烟、出生体重、发病时情况、药物及食物过敏史、家族史、免疫球蛋白、喂养方式、吸入激素、过敏体质、被动吸烟、免疫球蛋白、血常规、微量元素等指标进行Logistic回归分析。结果：单因素分析结果提示：性别、居住地、父亲吸烟与否、患儿出生时母亲年龄、分娩方式、出生体重、家庭装修与否、发病季节、毛细支气管炎期间住院天数、RSV感染、药物食物过敏史、被动吸娴、哮喘及过敏性鼻炎家族史、特应性体质、反复呼吸道感染、血IgE、血铅、血锌、血清铁、嗜酸细胞计数与毛细支气管炎后转化为哮喘有关。多因素非条件Logistic回归分析结果显示：性别（男孩）、患儿出生时母亲年龄、被动吸烟、春季发病、RSV感染阳性、出生体重异常、药物或食物过敏史、哮喘家族史、血IgE升高的毛细支气管炎患儿转化为儿童哮喘的危险性高。结论：对于毛细支气管炎患儿发展为哮喘的危险因素,应及早积极干预,降低发病率。     

Factors associated with asthma in school children

To investigate the factors associated with asthma in school children, a case-control study of 203 asthmatic and 203 non-asthmatic children (103 males and 100 females in each group) aged 6 to 18 years, was organized during the period September 1992 to May 1993 in Al Ain city, United Arab Emirates. Cases comprised known asthmatic children who were regularly receiving medication for asthma and were confirmed as asthmatics by a physician. Cases and controls were matched by age and sex. A questionnaire was used to obtain information about respiratory illnesses (pneumonia, bronchitis, bronchiolitis, sinusitis and croup); atopy (allergic rhinitis and atopic dermatitis) and familial allergic diseases (parental asthma and atopy). Information about socioeconomic status and limitations to children as a result of asthma were also obtained. Logistic regression analysis showed that bronchitis, atopy (allergic rhinitis and atopic dermatitis), croup, parental asthma and parental atopic dermatitis were significant risk factors for childhood asthma after adjusting for other confounding covariates. The model also showed that parental asthma (p < 0.0001) is much more influential than parental atopic dermatitis (p = 0.01) as a risk factor for asthma. Although pneumonia and sinusitis were significant risk factors when analyzed univariately, they were not significant after adjusting for other covariates. Bronchiolitis, smoking and socioeconomic status were beyond the reach of statistical significance as risk factors to asthma in our sample.     

成都市城区0~14岁哮喘儿童患病规律研究

目的 分析2010年成都市城区0~14岁儿童哮喘流行病学调查资料, 寻找哮喘儿童的某些发病规律和影响因素。方法 对551例筛查出的哮喘儿童, 由统一的呼吸专科医师采用回顾性调查填表法, 进行出生时间、首次哮喘发作年龄、哮喘发作频率及诱发因素、被动吸烟、家族哮喘及其它过敏病史、出生及喂养情况等的调查和分析;对照组270例为同时调查儿童中无过敏性疾病及反复呼吸道感染病史的健康儿童。结果 1)儿童哮喘患病率及哮喘的发作频率男童明显高于女童;2)不同的出生季节可影响哮喘的首次发病年龄, 秋季出生儿童的起病年龄最小;哮喘的首次发病年龄越小, 哮喘的发作频率越高;3)哮喘儿童中有哮喘家族史及其它过敏史者明显高于健康儿童;呼吸道感染是儿童哮喘发病的最主要诱因, 而被动吸烟、家庭装修、剖宫产及早期使用抗生素是哮喘发病的危险因素;4)出生后母乳喂养对哮喘的发病具有保护作用。结论 儿童哮喘的发病与遗传特异质有密切关系, 众多的外界环境因素影响着疾病的发生、发展和严重性。     

毛细支气管炎患儿临床严重程度与哮喘发生的相关因素分析

目的:观察毛细支气管炎严重程度与发生哮喘的发生率及相关因素。方法:采用回顾性分析和临床随访方法,选择2005年1月～2007年12月确诊为毛细支气管炎住院治疗患儿162例为研究对象。其中轻型毛细支气管炎患儿118例,重型毛细支气管炎患儿44例,统计哮喘发生率,观察其严重程度与哮喘发生的相关因素(患病情况、父母吸烟情况、家族病史、生活环境等),采用Logistic统计学方法对各可能因素与哮喘发生之间的关系及相关程度进行回归分析。结果:毛细支气管炎患儿162例转为哮喘47例(29.01%),重型毛细支气管炎患儿44例转为哮喘18例(40.91%),轻型毛细支气管炎患儿118例转为哮喘29例(24.58%),两者对比差异有统计学意义(P<0.05),重型毛细支气管哮喘、被动吸烟、过敏性体质患儿、家族病史等与继发哮喘显著相关(Pa<0.01)。结论:重型毛细支气管炎患儿易发展为哮喘,被动吸烟、过敏性体质和哮喘家族史是哮喘发生、发展高危因素。     

Prevalence of asthma and wheeze in relation to passive smoking in Japanese children

PURPOSE: Evidence remains inconclusive as to whether environmental tobacco smoke is a risk factor for allergic disorders in childhood. The present large-scale cross-sectional study examined the relationship between passive smoking at home and the prevalence of allergic disorders in Japanese schoolchildren. METHODS: Study subjects were 23,044 children aged 6 to 15 years in Okinawa. Outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, age, region of residence, number of siblings, paternal and maternal history of asthma, atopic eczema, or allergic rhinitis, as well as paternal and maternal educational level. RESULTS: The prevalence of wheeze, asthma, atopic eczema, and allergic rhinoconjunctivitis in the previous 12 months was 10.7%, 7.6%, 6.8%, and 7.7%, respectively. Current heavy passive smoking and 7.0 or more pack-years of smoking in the household were independently related to an increased prevalence of wheeze and asthma, especially in children 6 to 10 years of age and children with a positive parental allergic history. There was no dose-response relationship between pack-years of smoking in the household and atopic eczema or allergic rhinoconjunctivitis. CONCLUSIONS: Our findings suggested that environmental tobacco smoke might be associated with an increased prevalence of wheeze and asthma in Japanese children.     

Prognostic factors of severe asthma in Puerto Rico

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47% less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.     

Epidemiological study of hard metal asthma.

OBJECTIVES: To elucidate factors contributing to hard metal asthma, the entire workforce of a corporation producing hard metal tools (n = 703) was examined. METHODS: The variables evaluated were the atopy reflected by immunoglobulin E (IgE) antibody against mite allergen, history of exposure to hard metal, smoking, concentration of airborne cobalt, specific IgE antibody reaction against cobalt, and the respiratory symptom of attacks of reversible dyspnoea with wheeze (asthmatic symptoms). RESULTS: Univariate analysis showed that the prevalence of the asthmatic symptoms was significantly higher in formerly and currently exposed male workers than in non-exposed male workers. Positive IgE reaction against cobalt was found in seven men (2.0%), all of whom had asthmatic symptoms. Furthermore, it was found that atopy, positive IgE antibody against cobalt, and age of 40 or older were significantly correlated with asthmatic symptoms. Multilogistic analysis on the same factors and smoking in all of the workers showed that the age, experience of hard metal exposure, and atopy were significant risk factors associated with the asthmatic symptoms. Multilogistic analysis of data for currently exposed and non-exposed workers also showed that age and atopy were risk factors, and that the exposure to cobalt at the low concentration (at or below 50 micrograms/m3) but not at the higher concentration was a significant risk factor. Exposure to mist of coolants containing ionic cobalt, used during grinding, was not found to be any more hazardous in terms of onset of asthmatic symptoms than exposure to hard metal dust containing metallic cobalt. CONCLUSIONS: Accordingly, it is concluded that both environmental factors and individual susceptibility should be taken into consideration in efforts to reduce the prevalence of hard metal asthma.     

Pre-employment screening among trainee bakers.

OBJECTIVES--To assess the prevalence of atopy in a vocational school so as to evaluate the feasibility of pre-employment screening. METHODS--The prevalence of atopy by family diathesis, prick tests, immunoglobulin E (IgE) concentrations, and personal history of allergic respiratory diseases was investigated in 144 trainee bakers and 81 students on a graphic artists course (mean age 15.4 years). Skin sensitisation to wheat, rye, and barley flours, to alpha amylase, and to storage mites was also evaluated. RESULTS--Personal allergic symptoms were reported by 13.2% of the bakers and 14.7% of the graphic artists and there was a significant association between symptoms and atopy by prick tests (odds ratio (OR) 17.2; 95% confidence interval (95% CI) 5.27-56.4) and by family history (OR 3.11; 95% CI 1.02-9.53). When bakers were grouped according to the presence of allergic symptoms and results of immunological tests, 6.9% had asthma, 6.3% had rhinoconjunctivitis, and a high percentage (28.5%) were without symptoms but scored positive on prick tests or family symptoms. Skin sensitisation to storage mites had similar prevalences (16%) in the two groups of trainees and occurred nearly always in atopic people. Positive skin tests to wheat flour (3.5%), rye (0.7%), and alpha amylase (0.7%) were specific to bakers. CONCLUSIONS--Pre-employment screening is a useful source of medical information and allows for counseling. The presence of asthma, or of another allergic disease in a severe form, is suggested as a criterion for excluding students of a vocational school from training as bakers. Student bakers without allergic symptoms but atopic by other criteria should be informed about their risks of developing occupational asthma, and periodic check ups must be recommended. Screening studies in vocational school provide a better understanding of specificity of skin sensitisation to occupational allergens.     

Influence of Asthma on the Validity of Reported Lifelong Environmental Tobacco Smoke in the EGEA Study

The aim of this study was to assess the short-term reproducibility and the validity of reported ETS (environmental tobacco smoke) exposure, with a special emphasis on the potential misclassification related to personal or family history of asthma. Analyses were based on the data on the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA), a case-control study of asthma that included first degree relatives of asthmatic cases. The study was comprised of 348 families of asthmatics recruited in six chest clinics throughout France and 416 population-based controls. For studying the validity of ETS reports, personal active smoking histories reported by family members were taken as reference. The reproducibility of ETS exposure report was good, and independent of asthma. The validity of the report of maternal and paternal smoking in childhood and spouse smoking during life was high (overall agreement > or = 84%). Mothers of asthmatic children significantly underreported their smoking habits when questioned on their children's passive tobacco exposure. Offspring of parents who had stopped smoking underestimated their ETS exposure in childhood. In conclusion, interviews with mothers on their personal active smoking habits may provide a more accurate estimate of their asthmatic child's passive exposure than asking mothers specifically about their children's passive exposure. There was no indication that asthma status (either of the parent/spouse or of the respondent) by itself influences the report of ETS exposure during childhood or adulthood.     

Early childhood predictors of asthma

To investigate potential risk factors for the development of childhood asthma, the authors undertook a longitudinal study using a cohort of 770 children aged 5-9 years from East Boston, Massachusetts, that has been under study since 1975. The disease outcome considered was age at first onset of asthma, as determined by parental or self-reporting of a physician's diagnosis. Potential risk factors were evaluated specifically in relation to their presence antecedent to a diagnosis of asthma. Standardized questionnaires were used to obtain childhood illness histories, environmental exposures, and the asthmatic and atopic statuses of first-degree relatives. Ninety-one cases of asthma were identified from 1975 to 1988 (57 males and 34 females). Significant sex-adjusted relative risk estimates were seen for antecedent pneumonia, bronchitis, hay fever, sinusitis, parental asthma, and parental atopy. Neither bronchiolitis, eczema, croup, personal cigarette smoking, maternal smoking, paternal smoking, nor delivery complications bore an apparent relation to the development of asthma. A history of parental asthma or parental atopy did not significantly alter the sex-adjusted relative risk estimates for pneumonia, bronchitis, hay fever, or sinusitis. These results support the hypothesis that asthma is a multifactor disease whose expression is dependent on both familial and environmental influences.     

Efficacité pédagogique de la simulation dans l’apprentissage du sevrage tabagique par les étudiants en sciences de santé : Revue systématique

Background: Simulation is one of the educational tools that can be used in thelearning process to help with smoking cessation. Aim: To synthesize all the publications studying the contribution of simulation as aneducational tool in the acquisition of skills to help with smoking cessation. Methods: We performed a systematic review of the Francophone and Anglophoneliterature over the past 24 years (1997 to 2020) using the PubMed, Science Direct andCochrane Library databases. Results: A total of 14 articles were included. The most used methods were thestandardized patient, role play and video projection with discussion. The simulation hasnot only proved its effectiveness in terms of acquiring knowledge and self-confidencein the management of the smoking patient in the short term, but also in the acquisitionof verbal and non-verbal skills in the long term. Conclusion: This review highlighted the interest of simulation as an educational tool toacquire skills to help with smoking cessation regardless of the method used.     

诱发儿童哮喘的家庭环境危险因素分析

目的:分析儿童哮喘发病家庭环境的危险因素。方法:选择2009年1月～2011年1月在医院门诊及住院诊断为哮喘患儿400例,以同时期来医院治疗的非呼吸道疾病患儿403例为对照,采用问卷调查法调查与儿童哮喘有关的因素。结果:单因素分析显示,家族哮喘史、家族过敏史、过敏性体质、饲养动物、被动吸烟、使用空调、接触花粉、父母的受教育程度、经常情绪低落的比例哮喘组明显高于对照组,差异有统计学意义(P<0.01)。多因素非条件Logisitc回归分析显示家族哮喘史、过敏史、父母的受教育程度、被动吸烟、饲养动物5个因素差异有统计学意义(P<0.05)。结论:家族哮喘史、过敏史、父母的受教育程度、被动吸烟、饲养动物是儿童哮喘的危险因素,提示平时及时控制纠正与哮喘发生或发作的相关危险因素对儿童哮喘的预防与控制具有重要的实际意义。     

Intérêt pronostique du dosage de la troponine hyper-sensible dans la pré-éclampsie

Background:Pre-eclampsia is a pregnancy complication leading to significant morbidity and mortality. High-sensitivity troponin (hs-cTnI ) is one of the most sensitive cardiac biomarkers, but its variation in preeclampsia remains poorly studied. The aim of our study was to assess the prognostic value of hyper-sensitive troponin in preeclampsia. Methods:It was a prospective study including patients with preeclampsia. The exclusion criteria included conditions that may cause an elevation of hs-cTnI. Preoperative laboratory assessment included the determination of the level of hs-cTnI. The discriminative value of the preoperative hs-cTnI allowing to predict the onset of complications was evaluated by the ROC curve. Group A included patients whose rate was above the calculated cutoff, and group B included the others Results:Seventy seven patients were included. Complications occurred in 22% of cases. The preoperative hs-cTnI cutoff of 6.3 ng/l predicted the onset of complications (sensitivity 70.6% / specificity 86.6% / p <0.0001). There was a higher rate of severe pre-eclampsia and complications, a higher systolic and mean arterial blood pressure values in group A with significant differences. Both groups were comparable demographically, obstetrically, clinically and biologically. Conclusion :According to the results of our study, increased values of preoperative hs-cTnI may predict the onset of complications in pregnancies complicated by preeclampsia.     

Parental smoking modifies the relation between genetic variation in tumor necrosis factor-alpha (TNF) and childhood asthma

BACKGROUND: Polymorphisms in the proinflammatory cytokine genes tumor necrosis factor-alpha (TNF) and lymphotoxin-alpha (LTA, also called TNF-beta) have been associated with asthma and atopy in some studies. Parental smoking is a consistent risk factor for childhood asthma. Secondhand smoke and ozone both stimulate TNF production. OBJECTIVES: Our goal was to investigate whether genetic variation in TNF and LTA is associated with asthma and atopy and whether the association is modified by parental smoking in a Mexican population with high ozone exposure. METHODS: We genotyped six tagging single nucleotide polymorphisms (SNPs) in TNF and LTA, including functional variants, in 596 nuclear families consisting of asthmatics 4-17 years of age and their parents in Mexico City. Atopy was determined by skin prick tests. RESULTS: The A allele of the TNF-308 SNP was associated with increased risk of asthma [relative risk (RR) = 1.54; 95% confidence interval (CI), 1.04-2.28], especially among children of non-smoking parents (RR = 2.06; 95% CI, 1.19-3.55; p for interaction = 0.09). Similarly, the A allele of the TNF-238 SNP was associated with increased asthma risk among children of nonsmoking parents (RR = 2.21; 95% CI, 1.14-4.30; p for interaction = 0.01). LTA SNPs were not associated with asthma. Haplotype analyses reflected the single SNP findings in magnitude and direction. TNF and LTA SNPs were not associated with the degree of atopy. CONCLUSIONS: Our results suggest that genetic variation in TNF may contribute to childhood asthma and that associations may be modified by parental smoking.     

Chlamydia pneumoniae serological status is not associated with asthma in children or young adults

BACKGROUND: The factors that cause the allergic sensitization and inflammation in asthma still remain to be clarified. A role for Chlamydia pneumoniae has been suggested although serological studies have produced conflicting findings. This study aims to clarify the relationship between asthmatic variables and C. pneumoniae serological status. METHODS: A case-control study was undertaken on an asthma-enriched subset from a longitudinal birth cohort. In all, 198 subjects (96 with self-reported asthma) had C. pneumoniae serology (microimmunofluorescence [MIF] IgG, IgA) undertaken at age 11 and age 21 and assessment made in relation to a number of asthma variables. RESULTS: The only statistically significant finding was in subjects self-reporting asthma at age 21 who had evidence of lower IgG titres (P = 0.046), a finding in the opposite direction to that expected from the hypothesis. Subjects with high IgG titres (> or =128) were less likely to have reported ever having asthma; odds ratio (OR) = 0.29, (95% CI: 0.10-0.87). No association existed between symptoms suggestive of asthma in the previous 12 months and either IgG (P = 0.127) or IgA (P = 0.189) antibody titres at age 21. Likewise, no association was found between symptoms suggestive of asthma in the previous two years and C. pneumoniae IgG antibody titre (P = 0.81) at age 11. There was no evidence of an association with any of the other variables examined at either age 11 or age 21. These included use of inhaled steroids, serum IgE levels, airway responsiveness, skin test evidence of atopy, or smoking status. CONCLUSION: The results of this study suggest that C. pneumoniae infection when diagnosed by MIF serology is not a major risk factor for the development of asthma in children and young adults. The study has not, however, addressed the role this organism may play in specific asthmatic subsets or asthma exacerbations.     

Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study

Previous studies of how parental atopy and exposure to dampness and molds contribute to the risk of asthma have been mainly cross-sectional or prevalent case-control studies, where selection and information bias and temporality constitute problems. We assessed longitudinally the independent and joint effects of parental atopy and exposure to molds in dwellings on the development of asthma in childhood. We conducted a population-based, 6-year prospective cohort study of 1,984 children 1-7 years of age at the baseline in 1991 (follow-up rate, 77%). The study population included 1,916 children without asthma at baseline and complete outcome information. The data collection included a baseline and follow-up survey. The outcome of interest was development of asthma during the study period. The studied determinants were parental allergic diseases and four indicators of exposure at baseline: histories of water damage, presence of moisture and visible molds, and perceived mold odor in the home. A total of 138 (7.2%) children developed asthma during the study period, resulting in an incidence rate of 125 cases per 10,000 person-years [95% confidence interval (CI), 104-146]. In Poisson regression adjusting for confounding, parental atopy [adjusted incidence rate ratio (IRR) 1.52; 95% CI, 1.08-2.13] and the presence of mold odor in the home reported at baseline (adjusted IRR 2.44; 95% CI, 1.07-5.60) were independent determinants of asthma incidence, but no apparent interaction was observed. The results of this cohort study with assessment of exposure before the onset of asthma strengthen the evidence on the independent effects of parental atopy and exposure to molds on the development of asthma.     

Assessment and prediction of asthma and its severity in the pediatric community

Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (rs = .36) and treatment (rs = .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p = .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.