儿童哮喘

长期影响

针对来自新西兰和墨尔本队列的纵向研究数据表明，大多数在儿童晚期（从 7-9 岁）出现的哮喘形式一直延续到整个成年期。肺功能变化的形式与此类似，相对同龄儿童，5-12 岁儿童肺功能下降，但在整个儿童期，随着时间推移，肺功能未发生进一步相对恶化。[20]Sears MR, Greene JM, Willan AR, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med. 2003;349:1414-1422.http://www.nejm.org/doi/full/10.1056/NEJMoa022363#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/14534334?tool=bestpractice.com[250]Phelan PD, Robertson CF, Olinsky A. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol. 2002;109:189-194.http://www.ncbi.nlm.nih.gov/pubmed/11842286?tool=bestpractice.com[105]The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000;343:1054-1063.http://www.nejm.org/doi/full/10.1056/NEJM200010123431501#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11027739?tool=bestpractice.com[251]Morgan WJ, Stern DA, Sherrill DL, et al. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med. 2005;172:1253-1258.http://www.atsjournals.org/doi/full/10.1164/rccm.200504-525OC#.U_c7OvldU9Ihttp://www.ncbi.nlm.nih.gov/pubmed/16109980?tool=bestpractice.com 一些队列研究已发现，在有儿童期持续性哮喘既往史的人群中，在生命较晚期罹患慢性阻塞性肺疾病的风险更大。[252]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;374:1842-1852.http://www.ncbi.nlm.nih.gov/pubmed/27168434?tool=bestpractice.com[253]Tai A, Tran H, Roberts M, et al. The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax. 2014;69:805-810.http://www.ncbi.nlm.nih.gov/pubmed/24646659?tool=bestpractice.com[254]Tagiyeva N, Devereux G, Fielding S, et al. Outcomes of childhood asthma and wheezy bronchitis. A 50-year cohort study. Am J Respir Crit Care Med. 2016;193:23-30.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731615/http://www.ncbi.nlm.nih.gov/pubmed/26351837?tool=bestpractice.com

预期寿命

控制良好的哮喘儿童的预期寿命与普通人群是相当的。控制不良的哮喘和近期加重是病情进一步恶化的危险因素。[71]Global Initiative for Asthma. Global strategy for asthma management and prevention (2018 update). March 2018 [internet publication].http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/ 哮喘依然是发病率和死亡率的主要来源之一。

体育运动

充分控制哮喘的一个重要部分是使患者能维持正常的体力活动水平。不推荐将限制患者部分体力活动作为哮喘管理的一部分。体育训练（包括游泳）可改善患者心肺健康和生活质量。[168]Carson KV, Chandratilleke MG, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev. 2013;(9):CD001116.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001116.pub4/full[255]Crosbie A. The effect of physical training in children with asthma on pulmonary function, aerobic capacity and health-related quality of life: a systematic review of randomized control trials. Pediatr Exerc Sci. 2012;24:472-489.http://www.ncbi.nlm.nih.gov/pubmed/22971562?tool=bestpractice.com[256]Beggs S, Foong YC, Le HC, et al. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev. 2013;(4):CD009607.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009607.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23633375?tool=bestpractice.com 无论哮喘严重程度如何，游泳对稳定哮喘都没有不良影响。[256]Beggs S, Foong YC, Le HC, et al. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev. 2013;(4):CD009607.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009607.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23633375?tool=bestpractice.com

肥胖

肥胖或超重的患儿应执行减重计划，以减少呼吸系统症状。[70]British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. A national clinical guideline. September 2016 [internet publication].https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/

吸入用皮质类固醇对患者的影响

定期吸入皮质类固醇（特别是高剂量吸入）会对患者短期线性生长产生不良影响。在刚开始用药时会出现一过性身高增长速率变慢，而且可能会影响患者成人时的最终身高水平。证据 A线性生长影响和肾上腺抑制的效果：有高质量的证据表明，吸入性皮质类固醇抑制轻度至中度持续性哮喘和使用高剂量吸入性皮质类固醇的儿童的生长。[105]The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000;343:1054-1063.http://www.nejm.org/doi/full/10.1056/NEJM200010123431501#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11027739?tool=bestpractice.com[106]Sharek PJ, Bergman DA, Ducharme FM. Beclomethasone for asthma in children: effects on linear growth. Cochrane Database Syst Rev. 1999;(3):CD001282.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001282/fullhttp://www.ncbi.nlm.nih.gov/pubmed/10796632?tool=bestpractice.com[107]Guilbert TW, Mauger DT, Allen DB, et al; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute. Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone. J Allergy Clin Immunol. 2011;128:956-963.e7.http://www.jacionline.org/article/S0091-6749%2811%2900999-7/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/21820163?tool=bestpractice.com 停药后可能出现赶上生长现象，但不是所有儿童都出现此现象。[108]Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med. 2000;343:1064-1069.http://www.nejm.org/doi/full/10.1056/NEJM200010123431502#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11027740?tool=bestpractice.com[109]Kelly HW, Sternberg AL, Lescher R, et al; CAMP Research Group. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med. 2012;367:904-912.http://www.nejm.org/doi/full/10.1056/NEJMoa1203229#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/22938716?tool=bestpractice.com 年幼儿童和那些使用较高剂量吸入性皮质类固醇的儿童的风险更高。[107]Guilbert TW, Mauger DT, Allen DB, et al; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute. Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone. J Allergy Clin Immunol. 2011;128:956-963.e7.http://www.jacionline.org/article/S0091-6749%2811%2900999-7/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/21820163?tool=bestpractice.com 男孩患者（但不是女孩）会出现骨矿物质的沉积减少，但随骨质疏松的风险不会增加。[110]Kelly HW, Van Natta ML, Covar RA, et al. CAMP Research Group. The effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Pediatrics. 2008;122:e53-e61.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928657/http://www.ncbi.nlm.nih.gov/pubmed/18595975?tool=bestpractice.com[111]Adams N, Lasserson TJ, Cates CJ, et al. Fluticasone versus beclomethasone or budesonide for chronic asthma in adults and children. Cochrane Database Syst Rev. 2007;(4):CD002310.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002310.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17943772?tool=bestpractice.com 已经证明使用 800-3200 μg 的布地奈德患者会出现肾上腺抑制，在出现肾上腺危象病例中，经常与使用高剂量的氟替卡松有关。[112]Adams N, Bestall J, Jones PW. Budesonide at different doses for chronic asthma. Cochrane Database Syst Rev. 2001;(4):CD003271.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003271/fullhttp://www.ncbi.nlm.nih.gov/pubmed/11687182?tool=bestpractice.com[106]Sharek PJ, Bergman DA, Ducharme FM. Beclomethasone for asthma in children: effects on linear growth. Cochrane Database Syst Rev. 1999;(3):CD001282.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001282/fullhttp://www.ncbi.nlm.nih.gov/pubmed/10796632?tool=bestpractice.com[113]Todd GR, Acerini CL, Ross-Russell R, et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child. 2002 Dec;87(6):457-61.http://adc.bmj.com/content/87/6/457.longhttp://www.ncbi.nlm.nih.gov/pubmed/12456538?tool=bestpractice.com 环索奈德（与其他吸入用皮质类固醇相比）一直被认为不会对患者的身高和肾上腺功能产生有害影响，[114]Skoner DP, Maspero J, Banerji D, et al. Assessment of the long-term safety of inhaled ciclesonide on growth in children with asthma. Pediatrics. 2008 Jan;121(1):e1-14.http://www.ncbi.nlm.nih.gov/pubmed/18070931?tool=bestpractice.com 但一项 meta 分析显示结论相反。[115]Kramer S, Rottier BL, Scholten RJ, et al. Ciclesonide versus other inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev. 2013;(2):CD010352.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010352/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23450613?tool=bestpractice.com 曾有患者出现后囊白内障的相关报道，但一直没有发现长期使用低至中等剂量吸入性皮质类固醇是患者罹患白内障的一个危险因素。[101]Raissy HH, Sternberg AL, Williams P, et al. Risk of cataracts in the Childhood Asthma Management Program Cohort. J Allergy Clin Immunol. 2010;126:389-392.e4.http://www.jacionline.org/article/S0091-6749%2810%2900741-4/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/20621348?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。