儿童哮喘控制影响因素的研究进展

doi:10.20274/j.cnki.issn.1674-3865.2026.02.003

摘要/Abstract

摘要：

哮喘作为儿童最常见的慢性气道炎症性疾病，其控制状态密切影响疾病的负担和预后。尽管诊疗技术不断进步，全球及我国儿童哮喘控制率仍不理想。本文将从三个主要方面系统探讨影响儿童哮喘控制的因素：首先，讨论个体生物学特征，如性别、肥胖、共病等，如何在生理层面影响哮喘控制；其次，分析环境暴露因素，包括室外空气污染、室内变应原、烟草、呼吸道病毒等，如何加剧哮喘症状；最后，重点讨论管理行为，特别是治疗依从性和吸入装置使用技术对哮喘控制的影响，旨在为临床精准识别高危因素、制定个体化干预策略提供参考依据。

关键词: 哮喘, 哮喘控制, 影响因素, 儿童

Abstract:

Asthma is the most common chronic airway inflammatory disease in children, and its control status is closely related to the disease burden and prognosis. Despite the continuous advancement in diagnosis and treatment technologies, the control rate of childhood asthma globally and in China remains unsatisfactory. This article systematically elaborates on the factors affecting childhood asthma control from three aspects: first, discuss how the individual characteristics such as gender, obesity, comorbidities, etc. affect the asthma control physiologically; secondly, analyze how the environmental factors such as outdoor air pollution, indoor allergen exposure, tobacco exposure, and respiratory virus infections aggravate asthma symptoms; finally, the discussion focuses on management behaviors, especially the effect of treatment compliance and inhaler use techniques on asthma control. The aim is to provide a reference for accurately identifying high-risk factors and formulating individualized intervention strategies in clinical practice.

Key words: Asthma, Asthma control, Influencing factors, Child

中图分类号:

R725.6

靳礼政, 林佳霈, 孙涵宇, 黄光举. 儿童哮喘控制影响因素的研究进展[J]. 中国中西医结合儿科学, 2026, 18(2): 104-110.

Lizheng JIN, Jiapei LIN, Hanyu SUN, Guangju HUANG. Research progress on influencing factors for childhood asthma control[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2026, 18(2): 104-110.

参考文献 74

[1]	中华医学会儿科学分会呼吸学组, 中华儿科杂志编辑委员会, 中国医药教育协会儿科专业委员会. 儿童支气管哮喘诊断与防治指南(2025)[J]. 中华儿科杂志, 2025, 63(4):324-337.
[2]	Zheng J, Jin YJ, Wang CH, et al. Global, regional, and national epidemiology of allergic diseases in children from 1990 to 2021: findings from the Global Burden of Disease Study 2021[J]. BMC Pulm Med, 2025, 25(1): 54.
[3]	Venkatesan P. 2025 GINA report for asthma[J]. Lancet Respir Med, 2025, 13(8): e41-e42.
[4]	García-Marcos L, Chiang CY, Asher MI, et al. Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study[J]. Lancet Glob Health, 2023, 11(2): e218-e228.
[5]	熊浪宇, 曹学华, 王晓霞, 等. 国内儿童支气管哮喘控制不良及影响因素的Meta分析[J]. 护理实践与研究, 2024, 21(11): 1598-1608.
[6]	Xiang L, Zhao J, Zheng Y, et al. Uncontrolled asthma and its risk factors in Chinese children: a cross-sectional observational study[J]. J Asthma, 2016, 53(7): 699-706.
[7]	Arif MI, Ru L, Wang Y. Risk factors associated with uncontrolled asthma in children–a systematic review and meta-analysis[J]. J Asthma, 2024, 61(5): 387-395.
[8]	Cephus JY, Stier MT, Fuseini H, et al. Testosterone attenuates group 2 innate lymphoid cell-mediated airway inflammation[J]. Cell Rep, 2017, 21(9): 2487-2499.
[9]	Chiarella SE, Cardet JC, Prakash YS. Sex, cells, and asthma[J]. Mayo Clin Proc, 2021, 96(7): 1955-1969.
[10]	Resztak JA, Choe J, Nirmalan S, et al. Analysis of transcriptional changes in the immune system associated with pubertal development in a longitudinal cohort of children with asthma[J]. Nat Commun, 2023, 14(1): 230.
[11]	Borrelli R, Brussino L, Sardo LL, et al. Sex-based differences in asthma: pathophysiology, hormonal influence, and genetic mechanisms[J]. Int J Mol Sci, 2025, 26(11): 5288.
[12]	徐晓雯. 肥胖对不同年龄段哮喘患儿肺功能影响差异的分析[D]. 重庆：重庆医科大学, 2017.
[13]	Reyes-Angel J, Kaviany P, Rastogi D, et al. Obesity-related asthma in children and adolescents[J]. Lancet Child Adolesc Health， 2022，6(10):713-724.
[14]	王琴, 傅俊健, 杨梅, 等. 儿童哮喘严重程度与体重指数、脂联素和瘦素的关系[J]. 临床肺科杂志, 2021, 26(1): 50-53.
[15]	Fainardi V, Passadore L, Labate M, et al. An overview of the obese-asthma phenotype in children[J]. Int J Environ Res Public Health, 2022, 19(2): 636.
[16]	Huang YJ, Chu YC, Chen CW, et al. Relationship among genetic variants, obesity traits and asthma in the Taiwan Biobank[J]. BMJ Open Respir Res, 2022, 9(1): e001355.
[17]	Zhu Z, Li J, Si J, et al. A large-scale genome-wide association analysis of lung function in the Chinese population identifies novel loci and highlights shared genetic aetiology with obesity[J]. Eur Respir J, 2021, 58(4): 2100199.
[18]	Chen YC, Fan HY, Yang C, et al. Early pubertal maturation and risk of childhood asthma: a Mendelian randomization and longitudinal study[J]. Allergy, 2020, 75(4): 892-900.
[19]	Souza de Almeida AH, Rodrigues Filho EA, Lubambo Costa E, et al. Obesity is a risk factor for exercise-induced bronchospasm in asthmatic adolescents[J]. Pediatr Pulmonol, 2020, 55(8): 1916-1923.
[20]	Okoniewski W, Lu KD, Forno E. Weight loss for children and adults with obesity and asthma. A systematic review of randomized controlled trials[J]. Ann Am Thorac Soc, 2019, 16(5): 613-625.
[21]	Wu Z, Gao Z, Qiao Y, et al. Long-term results of bariatric surgery in adolescents with at least 5 years of follow-up: a systematic review and meta-analysis[J]. Obes Surg, 2023, 33(6): 1730-1745.
[22]	Yii ACA, Tay TR, Choo XN, et al. Precision medicine in united airways disease: a “treatable traits” approach[J]. Allergy, 2018, 73(10): 1964-1978.
[23]	Kou W, Li X, Yao H, et al. Meta-analysis of the comorbidity rate of allergic rhinitis and asthma in Chinese children[J]. Int J Pediatr Otorhinolaryngol, 2018, 107: 131-134.
[24]	Vieira RJ, Leemann L, Briggs A, et al. Poor rhinitis and asthma control is associated with decreased health-related quality of life and utilities: a MASK-air study[J]. J Allergy Clin Immunol Pract, 2024, 12(6): 1530-1538.
[25]	Liu Y, Sha J, Meng C, et al. Mechanism of lower airway hyperresponsiveness induced by allergic rhinitis[J]. J Immunol Res, 2022, 2022: 4351345.
[26]	Hyrkäs-Palmu H, Ikäheimo TM, Laatikainen T, et al. Cold weather increases respiratory symptoms and functional disability especially among patients with asthma and allergic rhinitis[J]. Sci Rep, 2018, 8(1): 10131.
[27]	Han X, Krempski JW, Nadeau K. Advances and novel developments in mechanisms of allergic inflammation[J]. Allergy, 2020, 75(12): 3100-3111.
[28]	Togias A, Gergen PJ, Hu JW, et al. Rhinitis in children and adolescents with asthma: ubiquitous, difficult to control, and associated with asthma outcomes[J]. J Allergy Clin Immunol, 2019, 143(3): 1003-1011.
[29]	Fritzsching B, Contoli M, Porsbjerg C, et al. Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: results from the REACT study, a retrospective cohort study[J]. Lancet Reg Health Eur, 2021, 13: 100275.
[30]	Bacharier LB, Jackson DJ. Biologics in the treatment of asthma in children and adolescents[J]. J Allergy Clin Immunol, 2023, 151(3): 581-589.
[31]	朱雯靓, 谷庆隆, 刘传合, 等. 儿童哮喘合并阻塞性睡眠呼吸暂停低通气综合征高危人群的临床特点[J]. 临床儿科杂志, 2024, 42(11): 922-926.
[32]	Wang D, Zhou Y, Chen R, et al. The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis[J]. Eur J Med Res, 2023, 28(1): 139.
[33]	Wang X, Zhang L, Chen H, et al. Mendelian randomization analysis and molecular mechanism study of childhood asthma and obstructive sleep apnea[J]. Hum Genet, 2025, 144(4): 443-461.
[34]	Saxena D, Imayama I, Adrish M. Revisiting asthma obstructive sleep apnea overlap: current knowledge and future needs[J]. J Clin Med, 2023, 12(20): 6552.
[35]	Sundbom F, Janson C, Ljunggren M, et al. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation[J]. J Clin Sleep Med, 2022, 18(11): 2635-2641.
[36]	Locke BW, Lee JJ, Sundar KM. OSA and chronic respiratory disease: mechanisms and epidemiology[J]. Int J Environ Res Public Health, 2022, 19(9): 5473.
[37]	Chatkin J, Correa L, Santos U. External environmental pollution as a risk factor for asthma[J]. Clin Rev Allergy Immunol, 2022, 62(1): 72-89.
[38]	Liu L, Liu C, Chen R, et al. Associations of short-term exposure to air pollution and emergency department visits for pediatric asthma in Shanghai, China[J]. Chemosphere, 2021, 263: 127856.
[39]	Kouis P, Galanakis E, Michaelidou E, et al. Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial[J]. Thorax, 2024, 79(6): 495-507.
[40]	Lee KS, Kim K, Choi YJ, et al. Increased sensitization rates to tree pollens in allergic children and adolescents and a change in the pollen season in the metropolitan area of Seoul, Korea[J]. Pediatr Allergy Immunol, 2021, 32(5): 872-879.
[41]	Norbäck D, Lu C, Wang J, et al. Asthma and rhinitis among Chinese children - Indoor and outdoor air pollution and indicators of socioeconomic status (SES)[J]. Environ Int, 2018, 115: 1-8.
[42]	Eguiluz-Gracia I, Mathioudakis AG, Bartel S, et al. The need for clean air: the way air pollution and climate change affect allergic rhinitis and asthma[J]. Allergy, 2020, 75(9): 2170-2184.
[43]	王慧渊, 郝娟娟, 张洋, 等. 5岁以下哮喘患儿血清过敏原病例对照研究及相关性分析[J]. 现代生物医学进展, 2020, 20(24): 4660-4664.
[44]	Heijink IH, Kuchibhotla VNS, Roffel MP, et al. Epithelial cell dysfunction, a major driver of asthma development[J]. Allergy, 2020, 75(8): 1902-1917.
[45]	Jutel M, Klimek L, Richter H, et al. House dust mite SCIT reduces asthma risk and significantly improves long-term rhinitis and asthma control-a RWE study[J]. Allergy, 2024, 79(4): 1042-1051.
[46]	de Moira AP, Strandberg-Larsen K, Bishop T, et al. Associations of early-life pet ownership with asthma and allergic sensitization: a meta-analysis of more than 77, 000 children from the EU Child Cohort Network[J]. J Allergy Clin Immunol, 2022, 150(1): 82-92.
[47]	Shi K, Lv Y, Zhao C, et al. Epithelial cell membrane perforation induces allergic airway inflammation[J]. Nature, 2025, 645(8080): 475-483.
[48]	Peters RL, Soriano VX, Lycett K, et al. Infant food allergy phenotypes and association with lung function deficits and asthma at age 6 years: a population-based, prospective cohort study in Australia[J]. Lancet Child Adolesc Health, 2023, 7(9): 636-647.
[49]	Ferrini M, Carvalho S, Cho YH, et al. Prenatal tobacco smoke exposure predisposes offspring mice to exacerbated allergic airway inflammation associated with altered innate effector function[J]. Part Fibre Toxicol, 2017, 14(1): 30.
[50]	Sunde RB, Thorsen J, Pedersen CT, et al. Prenatal tobacco exposure and risk of asthma and allergy outcomes in childhood[J]. Eur Respir J, 2022, 59(2): 2100453.
[51]	Wang SQ, Bao LJ, Li TY, et al. Potential health risk of human exposure to tobacco-specific nitrosamines in second-hand and third-hand smoke[J]. J Hazard Mater, 2024, 480: 136446.
[52]	Butz AM, Tsoukleris M, Elizabeth Bollinger M, et al. Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma[J]. J Asthma, 2019, 56(9): 915-926.
[53]	Li X, Zhang Y, Zhang R, et al. Association between E-cigarettes and asthma in adolescents: a systematic review and meta-analysis[J]. Am J Prev Med, 2022, 62(6): 953-960.
[54]	Gordon T, Karey E, Rebuli ME, et al. E-cigarette toxicology[J]. Annu Rev Pharmacol Toxicol, 2022, 62: 301-322.
[55]	Kloepfer KM, Kennedy JL. Childhood respiratory viral infections and the microbiome[J]. J Allergy Clin Immunol, 2023, 152(4): 827-834.
[56]	Looi K, Buckley AG, Rigby PJ, et al. Effects of human rhinovirus on epithelial barrier integrity and function in children with asthma[J]. Clin Exp Allergy, 2018, 48(5): 513-524.
[57]	Kim SR. Viral infection and airway epithelial immunity in asthma[J]. Int J Mol Sci, 2022, 23(17): 9914.
[58]	Diaz-Diaz A, Bunsow E, Garcia-Maurino C, et al. Nasopharyngeal codetection of Haemophilus influenzae and Streptococcus pneumoniae shapes respiratory syncytial virus disease outcomes in children[J]. J Infect Dis, 2022, 225(5): 912-923.
[59]	Novak N, Cabanillas B. Viruses and asthma: the role of common respiratory viruses in asthma and its potential meaning for SARS-CoV-2[J]. Immunology, 2020, 161(2): 83-93.
[60]	Loisel DA, Du G, Ahluwalia TS, et al. Genetic associations with viral respiratory illnesses and asthma control in children[J]. Clin Exp Allergy, 2016, 46(1): 112-124.
[61]	Conroy ER, Banzon TM, Simoneau T, et al. An overview of adherence-what it is and why it is important[J]. J Allergy Clin Immunol Pract, 2024, 12(12): 3180-3188.
[62]	罗南, 王玲, 袁小平, 等. 中国哮喘儿童治疗依从性影响因素的Meta分析[J]. 儿科药学杂志, 2023, 29(12): 5-12.
[63]	秦月香, 姚文英, 阐玉英, 等. 回授法教育在哮喘患儿及其照顾者中的应用[J]. 护理实践与研究, 2020, 17(23): 108-111.
[64]	郑姝麒, 彭东红. 长效抗胆碱能药物治疗支气管哮喘研究进展[J]. 儿科药学杂志, 2025, 31(5): 46-50.
[65]	Chan A, De Simoni A, Wileman V, et al. Digital interventions to improve adherence to maintenance medication in asthma[J]. Cochrane Database Syst Rev, 2022, 6(6): CD013030.
[66]	Sharrad KJ, Sanwo O, Cuevas-Asturias S, et al. Psychological interventions for asthma in children and adolescents[J]. Cochrane Database Syst Rev, 2024, 1(1): CD013420.
[67]	陈怡. 哮喘儿童吸入技术调查及相关因素分析[D]. 南充: 川北医学院, 2022.
[68]	Spaggiari S, Gehri M, Di Benedetto L, et al. Inhalation technique practical skills and knowledge among physicians and nurses in two pediatric emergency settings[J]. J Asthma, 2021, 58(2): 190-196.
[69]	Rodriguez-Martinez CE, Sossa-Briceño MP, Sinha IP. When adherence and inhalation technique matter: difficult-to-control pediatric asthma in low- to middle-income countries[J]. Pediatr Pulmonol, 2021, 56(6): 1366-1373.
[70]	Tran LC, Le MH, Bui NQ, et al. Impact of improper inhaler technique on pediatric asthma control in Vietnam: a cross-sectional study[J]. Sage Open Pediatr, 2025, 12: 30502225251325625.
[71]	Sportel E, Thio B, Movig K, et al. The correlation between the level of therapy adherence and inhalation technique in children with uncontrolled asthma using a smart inhaler: the IMAGINE study[J]. Ther Adv Respir Dis, 2025, 19: 17534666251346363.
[72]	Mahmood L, Sarkar KR, Neal K, et al. Video directly observed therapy to improve inhaler technique among pediatric patients with persistent asthma[J]. J Asthma, 2025, 62(9): 1591-1598.
[73]	Tony SM, Abdelrahman MA, Elsalam MA, et al. Effect of using acoustic flo-tone training device and its smartphone application on enhancing inhalation technique from metered-dose inhaler with spacer in asthmatic children[J]. Exp Lung Res, 2022, 48(7-8): 224-238.
[74]	Lizano-Barrantes C, Garin O, Mayoral K, et al. Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study[J]. Front Pharmacol, 2024, 15: 1340255.