在发达国家儿童哮喘是最常见的慢性呼吸系统疾病,在说英语的国家,例如美国、英国和澳大利亚其患病率最高。[3]Asher MI, Montefort S, Bjorksten B, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006 Aug 26;368(9537):733-43. [Erratum in: Lancet. 2007;370:1128.]http://www.ncbi.nlm.nih.gov/pubmed/16935684?tool=bestpractice.com 先前报道的持续增长的患病率逐渐趋于稳定甚至下降,最近报道的美国儿童的患病率为 8.5%。[4]Downs SH, Marks GB, Sporik R, et al. Continued increase in the prevalence of asthma and atopy. Arch Dis Child. 2001;84:20-23.http://adc.bmj.com/content/84/1/20.longhttp://www.ncbi.nlm.nih.gov/pubmed/11124778?tool=bestpractice.com[5]Anderson HR, Gupta R, Strachan DP, et al. 50 years of asthma: UK trends from 1955 to 2004. Thorax. 2007;62:85-90.http://www.ncbi.nlm.nih.gov/pubmed/17189533?tool=bestpractice.com[6]Asher MI. Recent perspectives on global epidemiology of asthma in childhood. Allergol Immunopathol (Madr). 2010;38:83-87.http://www.ncbi.nlm.nih.gov/pubmed/20106581?tool=bestpractice.com 在发展中国家,哮喘症状的患病率趋势走向不一,但总的来说呈上升趋势。[6]Asher MI. Recent perspectives on global epidemiology of asthma in childhood. Allergol Immunopathol (Madr). 2010;38:83-87.http://www.ncbi.nlm.nih.gov/pubmed/20106581?tool=bestpractice.com 性别影响哮喘的患病率,青春期前男性和青春期期后女性患病率较高。[7]Toelle BG, Xuan W, Peat JK, et al. Childhood factors that predict asthma in young adulthood. Eur Respir J. 2004;23:66-70.http://erj.ersjournals.com/content/23/1/66.fullhttp://www.ncbi.nlm.nih.gov/pubmed/14738233?tool=bestpractice.com[8]Aberg N, Engstrom I. Natural history of allergic diseases in children. Acta Paediatr Scand. 1990;79:206-211.http://www.ncbi.nlm.nih.gov/pubmed/2321483?tool=bestpractice.com 哮喘确切病因不清楚但可能与激素有关。[9]Almqvist C, Worm M, Leynaert B; working group of GA2LEN WP 2.5 Gender. Impact of gender on asthma in childhood and adolescence: a GA2LEN review. Allergy. 2008;63:47-57.http://www.ncbi.nlm.nih.gov/pubmed/17822448?tool=bestpractice.com 不同种族的患病率不同,在美国人群中,黑人的患病率最高。[10]Moorman JE, Rudd RA, Johnson CA, et al. National surveillance for asthma - United States, 1980-2004. MMWR Surveill Summ. 2007;56:1-54.http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htmhttp://www.ncbi.nlm.nih.gov/pubmed/17947969?tool=bestpractice.com 可能某些少数族裔人群的患病率被低估。[11]Brim SN, Rudd RA, Funk RH, et al. Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian. Pediatrics. 2008;122:e217-e222.http://www.ncbi.nlm.nih.gov/pubmed/18595967?tool=bestpractice.com
哮喘的控制良好和急性发作的预防是非常重要的。尽管有持续症状的儿童更容易出现哮喘严重急性发作,哮喘控制和急性发作仍不一致。[12]Wu AC, Tantisira K, Li L, et al; Childhood Asthma Management Program Research Group. Predictors of symptoms are different from predictors of severe exacerbations from asthma in children. Chest. 2011;140:100-107.http://journal.publications.chestnet.org/article.aspx?articleid=1088012http://www.ncbi.nlm.nih.gov/pubmed/21292760?tool=bestpractice.com 数据表明,严重哮喘急性发作与儿童肺功能更迅速下降有关,但此现象在青少年人群中并未出现,而且给予低剂量可吸入性激素进行治疗可以延缓肺功能衰减。[13]Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009;180:59-99.http://www.atsjournals.org/doi/full/10.1164/rccm.200801-060ST#.U_cpi_ldU9Ihttp://www.ncbi.nlm.nih.gov/pubmed/19535666?tool=bestpractice.com[14]O'Byrne PM, Pedersen S, Lamm CJ, et al. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179:19-24.http://www.atsjournals.org/doi/full/10.1164/rccm.200807-1126OC#.U_coafldU9Ihttp://www.ncbi.nlm.nih.gov/pubmed/18990678?tool=bestpractice.com 然而,在年幼儿童中使用吸入皮质类固醇哮喘不能改变哮喘的自然病程。[15]Nair P. Early interventions with inhaled corticosteroids in asthma: benefits and risks. Curr Opin Pulm Med. 2011;17:12-15.http://www.ncbi.nlm.nih.gov/pubmed/21116135?tool=bestpractice.com