UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

哮喘的自然病程

Authors
Augusto A Litonjua, MD
Scott T Weiss, MD, MS
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Robert A Wood, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
王琪, 主任医师，教授

引言

人们对哮喘自然病程的描述还不太详尽明确。最初从儿童期到成年早期对哮喘自然病程进行了研究的队列研究相对较少，并存在方法学问题，涉及受试者的选择(大部分是基于医院或诊所)和设计(很多是回顾性研究，未纳入气道反应性相关的生理测试且部分研究没有考查特应症的问题)[1]。然而在过去数年间，正在进行的前瞻性研究提供了更多可用的数据[2,3]。

儿童哮喘完全缓解的情况比成人更常见；但是，进展为严重疾病的情况在各年龄组都较为罕见[4,5]。尽管哮喘确实可导致死亡，但在无其他共存疾病时哮喘通常不影响预期寿命[6,7]。

本文将讨论从婴儿期到成年期的哮喘自然病程。哮喘的诊断和处理、吸入性糖皮质激素治疗对儿童期哮喘进展的影响，以及危险因素的作用将单独讨论。 (参见“12岁以下儿童的哮喘：使用控制药物治疗持续哮喘”和“哮喘的危险因素”和“哮喘管理概述”和“青少年及成人哮喘的诊断”)

婴儿和儿童

许多婴儿在生命早期出现喘鸣。那些由于下呼吸道疾病而发生喘鸣的婴儿在出现任何症状之前肺功能已下降[8]。例如，他们的气道可能更窄，这使他们面对病毒感染或者其他损伤时更易发生喘鸣。目前还不清楚哪些因素决定日后出现哮喘，不过已确定了一些可能的危险因素。 (参见“婴儿和儿童喘鸣的评估方法”)

在0-6岁发生的喘鸣 — 几项研究考查了喘鸣和哮喘在出生后最初6年内的自然病程。

         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-07 . | This topic last updated: 2017-03-28.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Weiss ST, Speizer FE. Epidemiology and natural history. In: Bronchial Asthma Mechanisms and Therapeutics, 3rd, Weiss EB, Stein M (Eds), Little, Brown, Boston 1993. p.15.
  2. Guilbert T, Krawiec M. Natural history of asthma. Pediatr Clin North Am 2003; 50:523.
  3. Bisgaard H, Bønnelykke K. Long-term studies of the natural history of asthma in childhood. J Allergy Clin Immunol 2010; 126:187.
  4. Ernst P, Cai B, Blais L, Suissa S. The early course of newly diagnosed asthma. Am J Med 2002; 112:44.
  5. Bronnimann S, Burrows B. A prospective study of the natural history of asthma. Remission and relapse rates. Chest 1986; 90:480.
  6. Silverstein MD, Reed CE, O'Connell EJ, et al. Long-term survival of a cohort of community residents with asthma. N Engl J Med 1994; 331:1537.
  7. McFadden ER Jr. Natural history of chronic asthma and its long-term effects on pulmonary function. J Allergy Clin Immunol 2000; 105:S535.
  8. Tager IB, Hanrahan JP, Tosteson TD, et al. Lung function, pre- and post-natal smoke exposure, and wheezing in the first year of life. Am Rev Respir Dis 1993; 147:811.
  9. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332:133.
  10. Dodge R, Martinez FD, Cline MG, et al. Early childhood respiratory symptoms and the subsequent diagnosis of asthma. J Allergy Clin Immunol 1996; 98:48.
  11. Vonk JM, Postma DS, Boezen HM, et al. Childhood factors associated with asthma remission after 30 year follow up. Thorax 2004; 59:925.
  12. Matricardi PM, Illi S, Grüber C, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J 2008; 32:585.
  13. Stern DA, Morgan WJ, Halonen M, et al. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet 2008; 372:1058.
  14. Kelly WJ, Hudson I, Phelan PD, et al. Childhood asthma in adult life: a further study at 28 years of age. Br Med J (Clin Res Ed) 1987; 294:1059.
  15. Oswald H, Phelan PD, Lanigan A, et al. Outcome of childhood asthma in mid-adult life. BMJ 1994; 309:95.
  16. Horak E, Lanigan A, Roberts M, et al. Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42. BMJ 2003; 326:422.
  17. Covar RA, Strunk R, Zeiger RS, et al. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol 2010; 125:359.
  18. Andersson M, Hedman L, Bjerg A, et al. Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013; 132:e435.
  19. Weiss ST, Tosteson TD, Segal MR, et al. Effects of asthma on pulmonary function in children. A longitudinal population-based study. Am Rev Respir Dis 1992; 145:58.
  20. Strunk RC, Weiss ST, Yates KP, et al. Mild to moderate asthma affects lung growth in children and adolescents. J Allergy Clin Immunol 2006; 118:1040.
  21. McGeachie MJ, Yates KP, Zhou X, et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. N Engl J Med 2016; 374:1842.
  22. Tai A, Tran H, Roberts M, et al. Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol 2014; 133:1572.
  23. Martin AJ, Landau LI, Phelan PD. Lung function in young adults who had asthma in childhood. Am Rev Respir Dis 1980; 122:609.
  24. Kelly WJ, Hudson I, Raven J, et al. Childhood asthma and adult lung function. Am Rev Respir Dis 1988; 138:26.
  25. Jenkins MA, Hopper JL, Bowes G, et al. Factors in childhood as predictors of asthma in adult life. BMJ 1994; 309:90.
  26. Godden DJ, Ross S, Abdalla M, et al. Outcome of wheeze in childhood. Symptoms and pulmonary function 25 years later. Am J Respir Crit Care Med 1994; 149:106.
  27. Dawson B, Illsley R, Horobin G, Mitchell R. A survey of childhood asthma in Aberdeen. Lancet 1969; 1:827.
  28. Edwards CA, Osman LM, Godden DJ, Douglas JG. Wheezy bronchitis in childhood: a distinct clinical entity with lifelong significance? Chest 2003; 124:18.
  29. Tantisira KG, Colvin R, Tonascia J, et al. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med 2008; 178:325.
  30. Zeiger RS, Dawson C, Weiss S. Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP). J Allergy Clin Immunol 1999; 103:376.
  31. Chipps BE, Szefler SJ, Simons FE, et al. Demographic and clinical characteristics of children and adolescents with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2007; 119:1156.
  32. Triebner K, Johannessen A, Puggini L, et al. Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study. J Allergy Clin Immunol 2016; 137:50.
  33. Settipane GA, Greisner WA 3rd, Settipane RJ. Natural history of asthma: a 23-year followup of college students. Ann Allergy Asthma Immunol 2000; 84:499.
  34. Sears MR. Consequences of long-term inflammation. The natural history of asthma. Clin Chest Med 2000; 21:315.
  35. Peat JK, Woolcock AJ, Cullen K. Rate of decline of lung function in subjects with asthma. Eur J Respir Dis 1987; 70:171.
  36. Ulrik CS, Lange P. Decline of lung function in adults with bronchial asthma. Am J Respir Crit Care Med 1994; 150:629.
  37. Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339:1194.
  38. Burrows B, Lebowitz MD, Barbee RA, Cline MG. Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample. J Allergy Clin Immunol 1991; 88:870.
  39. Dolan CM, Fraher KE, Bleecker ER, et al. Design and baseline characteristics of the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol 2004; 92:32.
  40. Miller MK, Johnson C, Miller DP, et al. Severity assessment in asthma: An evolving concept. J Allergy Clin Immunol 2005; 116:990.