2010-2011年北京地区14岁以上人群哮喘患病情况及相关危险因素的流行病学调查
|
摘要
研究背景
支气管哮喘(Bronchial asthma,简称哮喘)是由多种细胞(如嗜酸粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、树突状细胞、气道上皮细胞等)和细胞组分参与的一种以气道高反应(airway hyper responsiveness, AHR)、气道炎症和气道重塑为特征的常见慢性呼吸系统疾病之一。随着全球工业化和城市化进程不断加快、环境污染以及气候和生态环境的变化等因素的影响,哮喘发病率和死亡率呈逐年增高的趋势,目前中国约有2000万人罹患哮喘,死亡率位居全球之首。哮喘不仅对患者生活质量造成巨大影响,同时所产生的直接医疗费用和间接成本均造成了巨大个人和社会经济负担。因此积极防治哮喘是目前医学界所面临的共同课题。并且随着人们环境和生活方式的改变,哮喘的危险因素也在不断变化,所以对不同人群进行哮喘患病率及其相关危险因素的研究是非常具有现实意义的。
至今北京地区尚缺乏大样本高质量成人哮喘患病率及其相关危险因素的流行病学研究,且未形成有效的哮喘防治体系。北京哮喘流行病学的不足,已成为北京地区哮喘防控的瓶颈,影响了相关卫生政策和干预措施的制定。因此为全面了解北京地区哮喘患病率和相关危险因素的流行病学分布特点以及哮喘患者的临床特征、控制水平以及疾病的认知和管理的情况,我们利用北京市卫生局和中国哮喘联盟开展的“北京地区哮喘患病率及相关危险因素的调查研究”(首都医学发展科研基金项目)为平台,于2010年2月至2011年8月,通过多阶整群随机抽样的方法对北京地区年龄14岁以上人群展开了哮喘横断面调查,以了解北京地区哮喘的流行病学特点,为北京地区哮喘的预防和控制提供科学依据。研究结果来源于该研究的基线数据。本人是该研究的主要成员,主要负责该调查的组织实施、资料的整理归档和数据的统计分析工作。
目的
1.调查2010-2011年北京地区年龄14岁以上人群的哮喘患病率情况,明确北京地区哮喘的流行趋势。
2.初步探讨北京地区哮喘发病相关的危险因素,明确诱发或加重哮喘的常见诱发因素。获得北京地区哮喘相关危险因素的分布特点。
3.了解北京地区哮喘患者的常见临床症状、合并疾病等临床特征。
4.获得目前北京地区哮喘患者的控制水平、疾病的认知和管理程度以及哮喘对患者生活质量的影响。
方法
1.对象：以北京地区年龄14岁以上的全部常住居民为研究目标人群,以其中多阶整群随机抽样确定并符合入选标准的居民为研究对象。研究对象入选标准为：(1)年龄14岁以上,性别不限；(2)具有北京市户籍且于北京连续居住2年以上或非北京市户籍于北京连续居住3年以上的北京市常住居民。
2.方法：2010年2月至2011年8月,采用多阶整群随机抽样：北京市行政区划共有16个区、2个县,按照城区、近郊区及远郊区县分为3类。城区4个：东城、西城、宣武、崇文；近郊区4个：海淀、朝阳、石景山、丰台；远郊区县10个：通州、门头沟、大兴、房山、昌平、顺义、怀柔、平谷、密云区和延庆县。首先从3类区域内各抽取2个城区或县,然后按同样方法分别于所抽2个城区或县内随机抽取1-2个乡镇或下属街道办事处,最后分别于所抽1-2个乡镇或下属街道办事处内分别各抽取1-2个社区或村。当抽样落实到社区或村时,对其辖区内的所有符合入选标准条件的居民全部纳入。于城区、近郊区和远郊区内各抽取样本数20000人,抽样共计约60000人。根据病史、体征和肺功能检查确诊哮喘患者,研究北京地区哮喘患病率和相关危险因素的流行病学分布特点。然后对所确诊的哮喘患者进一步行哮喘控制水平、疾病的认知和管理程度、哮喘对患者生活质量的影响等方面详细问卷的填写,以了解北京地区哮喘患者的控制、认知和管理水平。调查完毕后将所有调查问卷汇总并进行审核,对每份试卷进行编码和整理归档。最后将调查问卷及相应的入档号由专人双份录入、双向核对,以确保数据准确。
3.统计分析：所有数据资料采用计算机Epidata3.1软件录入和存储,以SAS9.2软件包进行统计学处理。计量资料采用最大值、最小值、均数±标准差(x±s)描述；计数资料以率、构成比、相对比及频数分布等表示。率的比较采用χ2检验或趋势χ2检验。样本均数间的比较采用单因素方差分析或非参数检验。以P<0.05为差异有统计学意义。
结果
1.入户调查共计61107人,回收有效调查问卷57647份；确诊哮喘患者687例,其中男296例,女391例；北京地区哮喘总体患病率为1.19%(687/57647),其中郊区人群患病率为1.40%(269/19179),显著高于市区的1.09%(418/38468)(χ2=10.850,P=0.001)；女性患病率为1.32%(391/29700),显著高于男性的1.06%(296/27947)(χ2=8.098,P=0.004)。不同年龄段人群哮喘患病率差异也有统计学意义(χ2=404.874,P<0.005)。市区与郊区人群患病率分别较2002年增高了1.12倍和2.26倍。
2.女性、主动吸烟史、肥胖、合并过敏性疾病、14岁之前曾患有肺炎、气管／支气管炎、结核、过敏性鼻炎或湿疹、直系亲属患有哮喘和居住地为郊区可能是哮喘患病的危险因素。37.1%(255/687)哮喘患者存在诱发或加重哮喘的危险因素,常见的诱发因素依次为接触冷空气(154/687)、气候变化(141/687)、刺激性气体(120/687)、感冒(111/687)、劳累(75/687)、运动(67/687)和情绪紧张或激动(56/687)和吸烟(55/687)。
3.本次调查共检出687名哮喘患者,年龄平均(60.7±16.5)岁,哮喘病程平均(20.8±17.3)年。哮喘患者中以高中以下文化程度者居多,职业分布以工人和农民为主。本次调查研究首次确诊哮喘患者198例,占全部哮喘患者的28.8%(198/687)。北京地区哮喘患者自诉其哮喘发作或加重时最严重的三种症状依次为：喘息(383/687)、气急(167/687)和胸闷(154/687)；常见症状依次为：喘息(557/687)、胸闷(497/687)、咳嗽(484/687)。哮喘患者有主动吸烟史者占31.9%(219/687)。哮喘患者合并过敏性鼻炎者占32.9%,合并湿疹者占9.3%,合并过敏性眼结膜炎者占5.5%,合并胃食管反流性疾病者占4.4%。
4.本调查的哮喘控制测试评分显示,北京地区34.9%(240/687)哮喘患者达到哮喘控制,39.2%(269/687)处于部分控制,25.9%(178/687)处于未控制。在过去1年中21.3%(146/687)患者因哮喘加重而看急诊,14.0%(96/687)因哮喘加重住院。患者对哮喘的炎症本质和哮喘治疗目标的正确认识率分别为13.5%(93/687)和15.1%(104/687)。哮喘患者规律使用吸入激素的比例仅12.1%(83/687)。71.2%(489/687)患者在最近1年中未做过肺功能检查,12.3%(84/687)患者拥有峰流速仪,每日规律使用峰流速仪者仅占1.5%(10/687)。46.6%(320/687)患者因哮喘在娱乐、教育、生育和就业中受限,甚至3.6%(25/687)想过自杀。
结论
1.北京地区哮喘流行病学形势非常严峻,市区和郊区患病率较十年前均有大幅增高,其中女性高于男性,郊区高于市区。不同年龄、职业、受教育程度人群间哮喘患病率均存在差异。
2.影响北京地区哮喘发病的相关危险因素众多,既包括宿主因素如遗传因素、特应质、性别和肥胖,也包括主动吸烟史、儿时罹患肺炎、气管／支气管炎、结核类呼吸道感染性疾病、居住在郊区等环境因素。37.1%患者存在哮喘发作或加重的诱发因素,常见的诱发因素依次为接触冷空气、气候变化、刺激性气体、感冒、劳累、运动和情绪紧张或激动和吸烟。
3.本次调查共检出687名哮喘患者,其中首次确诊哮喘患者198例,占此次全部确诊哮喘患者的28.8%。哮喘患者中以高中以下文化程度者居多,职业分布以工人和农民为主。北京地区哮喘患者自诉其哮喘发作或加重时最严重的三种症状依次为：喘息、气急和胸闷；常见症状依次为：喘息、胸闷和咳嗽。31.9%的哮喘患者有吸烟史。哮喘患者合并过敏性鼻炎者占32.9%,合并湿疹者占9.3%,合并过敏性眼结膜炎者占5.5%,合并胃食管反流性疾病者占4.4%。
4.本调查的哮喘控制测试评分显示,北京地区34.9%患者达到了哮喘控制,39.2%处于部分控制,25.9%处于未控制。哮喘患者的控制水平较前有所提高,但与GINA指南所推荐的治疗目标尚存差距,急诊率和住院率仍处于较高水平。患者对疾病的认知和病情的自我监测程度仍然较低。哮喘控制不佳对患者日常活动和心理社会功能均造成了很大影响。应进一步加强哮喘患者的教育和管理,避免哮喘的致病因素和诱发因素、减少急性加重。指导患者长期规范化治疗从而提高患者生活质量、降低疾病负担。
Background
Bronchial asthma (asthma) is a chronic pulmonary disease in which many cells (eosinophils, mast cells, T lymphocytes, neutrophils, dendritic cells, airway epithelial cells) and cellular elements play an important role. The disorder of the airway is characterized by airway hyper responsiveness (AHR), airway inflammation, and airway remodeling. With the effect of industrialized and urbanization, climate change and environmental or ecology pollution, the prevalence rate and mortality of asthma are increasing year by year. Asthma is also a problem in China, with an estimated20million affected individuals. It not only reduces the quality life of individual but also brings the serious burden to the social economic and the family because of the great cost. Therefore, asthma has been the universal subject of prevention. Moreover, the factors that influence the risk of asthma are gradually changing with the ecology and lifestyle. So the epidemiology survey on prevalence and risk factors of asthma in different regions will make great significance on asthma prevention.
However, there is not much information on the epidemiological study of asthma in Beijing among the adults, especially lack of the effective prevention and treatment systems about it. The intervention measures and policy were not put into practice because of the deficiency of epidemiological survey data in Beijing. Then a comprehensive study was conducted to investigate the prevalence, risk factors, clinical feature, control level and reality of asthma. A collaboration of Beijing Health Bureau and China Asthma Alliance, provide an excellent platform to the epidemiological survey on prevalence rate and the associated risk factors of asthma in Beijing area (Projects in the Capital medical development scientific research). A cross-sectional study was carried out in this study (February2010to August2011) in Beijing residents among the people who aged more than14years. The multi-stage random cluster sampling methods was applied to obtain study subjects. In this report, the baseline data of the project was used. The author is one of the investigators of the project, responsible for coordination and inspection of the study field and data management and analysis.
Objective
1. To survey the prevalence rate and risk factors of bronchial asthma in Beijing area among the people who aged more than14years from2010to2011.
2. To obtain the clinical feature of asthmatic patients in Beijing area such as clinical syndromes, combinations, triggers and so on.
3. To evaluate the current level of asthma control and their insights and self-management from asthmatics and then assess the impaction on quality life of asthmatics.
Methods
1. Subjects:The people who aged more than14years in Beijing area were the target population of the study. And the objects were obtained by stratified cluster random sampling. The criterion of objects were as follow:(1) The age of the individual was more than14years, male or female;(2) People who had register of Beijing and lived here for no less than2years or those residents who had not registered of Beijing but lived here longer than3years.
2. Methods:From February2010to August2011, a cross-sectional study was carried out in this study. The multi-stage random cluster sampling methods was applied to obtain study subjects. The16districts and2counties of Beijing were classified in to three categories as urban (Dongcheng, Xicheng, Xuanwu and Chongwen), suburb (Haidian, Chaoyang, Shijingshan and Fengtai) and outskirt (Tongzhou, Mentougou, Daxing, Fangshan, Changping, Shunyi, Huairou, Pinggu, Miyun and Yanqing). Steps1,2districts or counties were randomly selected in each category. Step2, in each of the2selected districts or counties,1-2towns or street offices were randomly sampled as the target towns or street offices. Step3, in each of the1-2selected towns or street offices,1-2communities or villages were randomly sampled as the target communities or villages in each of the grade from grade1to grade4. Steps4, all of the residents in the selected communities or villages were sampled. Every districts or counties were sampled20000, and the total sample size was about60000.
Home visit completion of epidemiological questionnaires was conducted. And the asthmatics were diagnosed based upon case history, clinical signs and lung function test. Then the epidemiological status of Beijing area on prevalence and risk factors were investigated. Detailed epidemiology data on asthma control and reality was collected via face-to-face home visit interviews among the asthmatics so the control level and of asthma was investigated. All of the epidemiological questionnaires were collected and checked. Then they were coded and filed. At last, the questionnaires and their codes were input and checked by the professional person twice so that the data could correctly input.
3. Statistical Analysis:The version3.1of Epidata system was used for data entry and the data were analyzed using SAS9.2software package. The General social characteristics of all the participants were described. Minium, Maximum, Means and standard errors were calculated for measurement data. And prevalence rate, relative rate and constituent ratio were calculated for numeration data. Analysis of variance or nonparametric statistics were used to compare statistical differences of variables. Chis-square test or trend chi-square was used to compare statistical differences of prevalence rates. A2-tailed P value less than0.05was considered statistically significant.
Results
1. In total, sampling population was61107and57647questionnaires were valid actually. Of which687had asthma. Male asthmatics were296and female asthmatics were391. The overall prevalence rate was1.19%(687/57647). The asthma prevalence rates in urban and suburb of Beijing area were1.09%(418/38468) and1.40%(269/19179) respectively and the prevalence rate of asthma in suburb area was significantly higher than that of urban area (χ2=10.850, P=0.001). The asthma prevalence rates in male and female were1.06%(296/27947) and1.32%(391/29700) respectively and the prevalence rate of asthma in female was much higher than that of male (χ2=8.098, P=0.004). There was a significant difference among different age groups (χ2=404.874, P <0.005). The asthma prevalence rates in urban and suburb of Beijing area were highly increased by1.12and2.26times respectively than that of2002.
2. The risk factors associated with asthma may be female, active smoking, obesity, combination of allergic rhinitis, diagnosis of pneumonia, bronchitis/bronchiolitis, tuberculosis, allergy rhinitis, eczema, and direct relatives diagnosed of asthma and living in the suburb.255asthmatics were attacked or aggravated by some triggers which accounted for37.1%in all asthma patients. Patients-reported asthma triggers were exposure to cold air (154/687), climate change (141/687), irritant gas (120/687), catching a cold (111/687), tired (75/687), exercise (67/687), stress or nervous (56/687) and smoking (55/687).
3. A total of687asthmatic patients were detected in this survey with a mean age of (60.7±16.5) years and disease duration of (20.8±17.3) years.198asthmatics were first diagnosed in this survey which accounted for28.8%(198/687) in all asthma patients that were diagnosed in the survey.15.0%(103/687) asthmatics were diagnosed as asthma when they were in their childhood before14years. The severe symptoms that the asthmatics self-reported when they episodes were wheeze (383/687), shortness of breath (167/687) and dyspnea (154/687). The predominant symptoms that the asthmatics self-reported were wheeze (557/687) followed by dyspnea (497/687) and cough (484/687). The smoking rate of asthmatic patients was31.9%(219/687). The asthmatics who had a complication of allergic rhinitis, eczema, allergy conjunctivitis or GRED were accounted for32.9%,9.3%,5.5%and4.4%respectively.
4. In this study, according to the ACT test,34.9%(240/687) of the asthmatics in Beijing area had complete control,39.2%(269/687) had partially control and25.9%(178/687) had poorly controlled asthma. In the past year,21.3%(146/687) of patients reported emergency room visit at least one time within the past year due to asthma exacerbation and14.0%(96/687) had been hospitalized because of sudden attacks.13.5%(93/687) of the asthmatics knew that the intrinsic feature of asthma was inflammation and5.1%(104/687) of the asthmatics understood the treatment goal of this disease. Only12.1%(83/687) patients used inhaled corticosteroids regularly.71.2%(489/687) asthmatics had never undergone a lung functional test in the past year.12.3%(84/687) had a device for peak flow meter of their own but only1.5%(10/687) monitored peak flow regularly.46.6%(320/687) asthmatics reported that their activities including entertainment, learning, fertility and employment were limited due to asthma, Even3.6%(25/687) had mind of suicide.
Conclusions
1. The prevalence rate of asthma in urban and suburb are highly increased than ten years ago and it posed urgent situation to us. The prevalence rate of asthma in suburb area was significantly higher than that of urban area and the prevalence rate of asthma in female was much higher than that of male. There are significant different prevalence rates between different ages, occupations and education level but There is no differences between Han and Non-Han race.
2. There are many kinds of associated risk factors of asthma. Host factors such as atopy, sex, obesity and environmental factors included history of smoking, respiratory tract infection disease in childhood included pneumonia, bronchitis/bronchiolitis, tuberculosis and living in the suburb.255asthmatics were attacked or aggravated by some triggers which accounted for37.1%in all asthma patients. Patients-reported asthma triggers were exposure to cold air, climate change irritant gas, catching a cold, tired, exercise, stress or nervous and smoking.
3.687asthmatics were detected and198asthmatics were first diagnosed in this survey which accounted for28.8%in all asthma patients that were diagnosed in the survey. The severe symptoms that the asthmatics self-reported when they episodes were wheeze, shortness of breath and dyspnea The predominant symptoms that the asthmatics self-reported were wheeze followed by dyspnea and cough. The asthmatic patients who had history of smoking was accounted for31.9%. The asthmatics who had a complication of allergic rhinitis, eczema, allergy conjunctivitis or GRED were accounted for32.9%,9.3%,5.5%and4.4%respectively.
4. In this study,34.9%of the asthmatics in Beijing area had complete control,39.2%had partially control and25.9%had poorly controlled asthma. The level of asthma control in Beijing area has been improved greatly but it still falls down far below the GINA goals and there were also many times of emergency room visits and hospitalizations of asthmatics in Beijing area in the last year. The level of self-monitoring and insight about the disease among the asthmatics were very low. Activity limited, psychological and social functions were largely impacted by the disease because of the uncontrolled asthma. Therefore it is necessary to educate the asthmatics, guide the patients to the long-term management and standardized therapy and avoid the cause and the triggers of asthma. And then the times of exacerbations of asthma would be reduced and thus the life quality of asthmatics would be improved and the burden of this disease on society would be reduced.
支气管哮喘(Bronchial asthma,简称哮喘)是由多种细胞(如嗜酸粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、树突状细胞、气道上皮细胞等)和细胞组分参与的一种以气道高反应(airway hyper responsiveness, AHR)、气道炎症和气道重塑为特征的常见慢性呼吸系统疾病之一。随着全球工业化和城市化进程不断加快、环境污染以及气候和生态环境的变化等因素的影响,哮喘发病率和死亡率呈逐年增高的趋势,目前中国约有2000万人罹患哮喘,死亡率位居全球之首。哮喘不仅对患者生活质量造成巨大影响,同时所产生的直接医疗费用和间接成本均造成了巨大个人和社会经济负担。因此积极防治哮喘是目前医学界所面临的共同课题。并且随着人们环境和生活方式的改变,哮喘的危险因素也在不断变化,所以对不同人群进行哮喘患病率及其相关危险因素的研究是非常具有现实意义的。
至今北京地区尚缺乏大样本高质量成人哮喘患病率及其相关危险因素的流行病学研究,且未形成有效的哮喘防治体系。北京哮喘流行病学的不足,已成为北京地区哮喘防控的瓶颈,影响了相关卫生政策和干预措施的制定。因此为全面了解北京地区哮喘患病率和相关危险因素的流行病学分布特点以及哮喘患者的临床特征、控制水平以及疾病的认知和管理的情况,我们利用北京市卫生局和中国哮喘联盟开展的“北京地区哮喘患病率及相关危险因素的调查研究”(首都医学发展科研基金项目)为平台,于2010年2月至2011年8月,通过多阶整群随机抽样的方法对北京地区年龄14岁以上人群展开了哮喘横断面调查,以了解北京地区哮喘的流行病学特点,为北京地区哮喘的预防和控制提供科学依据。研究结果来源于该研究的基线数据。本人是该研究的主要成员,主要负责该调查的组织实施、资料的整理归档和数据的统计分析工作。
目的
1.调查2010-2011年北京地区年龄14岁以上人群的哮喘患病率情况,明确北京地区哮喘的流行趋势。
2.初步探讨北京地区哮喘发病相关的危险因素,明确诱发或加重哮喘的常见诱发因素。获得北京地区哮喘相关危险因素的分布特点。
3.了解北京地区哮喘患者的常见临床症状、合并疾病等临床特征。
4.获得目前北京地区哮喘患者的控制水平、疾病的认知和管理程度以及哮喘对患者生活质量的影响。
方法
1.对象：以北京地区年龄14岁以上的全部常住居民为研究目标人群,以其中多阶整群随机抽样确定并符合入选标准的居民为研究对象。研究对象入选标准为：(1)年龄14岁以上,性别不限；(2)具有北京市户籍且于北京连续居住2年以上或非北京市户籍于北京连续居住3年以上的北京市常住居民。
2.方法：2010年2月至2011年8月,采用多阶整群随机抽样：北京市行政区划共有16个区、2个县,按照城区、近郊区及远郊区县分为3类。城区4个：东城、西城、宣武、崇文；近郊区4个：海淀、朝阳、石景山、丰台；远郊区县10个：通州、门头沟、大兴、房山、昌平、顺义、怀柔、平谷、密云区和延庆县。首先从3类区域内各抽取2个城区或县,然后按同样方法分别于所抽2个城区或县内随机抽取1-2个乡镇或下属街道办事处,最后分别于所抽1-2个乡镇或下属街道办事处内分别各抽取1-2个社区或村。当抽样落实到社区或村时,对其辖区内的所有符合入选标准条件的居民全部纳入。于城区、近郊区和远郊区内各抽取样本数20000人,抽样共计约60000人。根据病史、体征和肺功能检查确诊哮喘患者,研究北京地区哮喘患病率和相关危险因素的流行病学分布特点。然后对所确诊的哮喘患者进一步行哮喘控制水平、疾病的认知和管理程度、哮喘对患者生活质量的影响等方面详细问卷的填写,以了解北京地区哮喘患者的控制、认知和管理水平。调查完毕后将所有调查问卷汇总并进行审核,对每份试卷进行编码和整理归档。最后将调查问卷及相应的入档号由专人双份录入、双向核对,以确保数据准确。
3.统计分析：所有数据资料采用计算机Epidata3.1软件录入和存储,以SAS9.2软件包进行统计学处理。计量资料采用最大值、最小值、均数±标准差(x±s)描述；计数资料以率、构成比、相对比及频数分布等表示。率的比较采用χ2检验或趋势χ2检验。样本均数间的比较采用单因素方差分析或非参数检验。以P<0.05为差异有统计学意义。
结果
1.入户调查共计61107人,回收有效调查问卷57647份；确诊哮喘患者687例,其中男296例,女391例；北京地区哮喘总体患病率为1.19%(687/57647),其中郊区人群患病率为1.40%(269/19179),显著高于市区的1.09%(418/38468)(χ2=10.850,P=0.001)；女性患病率为1.32%(391/29700),显著高于男性的1.06%(296/27947)(χ2=8.098,P=0.004)。不同年龄段人群哮喘患病率差异也有统计学意义(χ2=404.874,P<0.005)。市区与郊区人群患病率分别较2002年增高了1.12倍和2.26倍。
2.女性、主动吸烟史、肥胖、合并过敏性疾病、14岁之前曾患有肺炎、气管／支气管炎、结核、过敏性鼻炎或湿疹、直系亲属患有哮喘和居住地为郊区可能是哮喘患病的危险因素。37.1%(255/687)哮喘患者存在诱发或加重哮喘的危险因素,常见的诱发因素依次为接触冷空气(154/687)、气候变化(141/687)、刺激性气体(120/687)、感冒(111/687)、劳累(75/687)、运动(67/687)和情绪紧张或激动(56/687)和吸烟(55/687)。
3.本次调查共检出687名哮喘患者,年龄平均(60.7±16.5)岁,哮喘病程平均(20.8±17.3)年。哮喘患者中以高中以下文化程度者居多,职业分布以工人和农民为主。本次调查研究首次确诊哮喘患者198例,占全部哮喘患者的28.8%(198/687)。北京地区哮喘患者自诉其哮喘发作或加重时最严重的三种症状依次为：喘息(383/687)、气急(167/687)和胸闷(154/687)；常见症状依次为：喘息(557/687)、胸闷(497/687)、咳嗽(484/687)。哮喘患者有主动吸烟史者占31.9%(219/687)。哮喘患者合并过敏性鼻炎者占32.9%,合并湿疹者占9.3%,合并过敏性眼结膜炎者占5.5%,合并胃食管反流性疾病者占4.4%。
4.本调查的哮喘控制测试评分显示,北京地区34.9%(240/687)哮喘患者达到哮喘控制,39.2%(269/687)处于部分控制,25.9%(178/687)处于未控制。在过去1年中21.3%(146/687)患者因哮喘加重而看急诊,14.0%(96/687)因哮喘加重住院。患者对哮喘的炎症本质和哮喘治疗目标的正确认识率分别为13.5%(93/687)和15.1%(104/687)。哮喘患者规律使用吸入激素的比例仅12.1%(83/687)。71.2%(489/687)患者在最近1年中未做过肺功能检查,12.3%(84/687)患者拥有峰流速仪,每日规律使用峰流速仪者仅占1.5%(10/687)。46.6%(320/687)患者因哮喘在娱乐、教育、生育和就业中受限,甚至3.6%(25/687)想过自杀。
结论
1.北京地区哮喘流行病学形势非常严峻,市区和郊区患病率较十年前均有大幅增高,其中女性高于男性,郊区高于市区。不同年龄、职业、受教育程度人群间哮喘患病率均存在差异。
2.影响北京地区哮喘发病的相关危险因素众多,既包括宿主因素如遗传因素、特应质、性别和肥胖,也包括主动吸烟史、儿时罹患肺炎、气管／支气管炎、结核类呼吸道感染性疾病、居住在郊区等环境因素。37.1%患者存在哮喘发作或加重的诱发因素,常见的诱发因素依次为接触冷空气、气候变化、刺激性气体、感冒、劳累、运动和情绪紧张或激动和吸烟。
3.本次调查共检出687名哮喘患者,其中首次确诊哮喘患者198例,占此次全部确诊哮喘患者的28.8%。哮喘患者中以高中以下文化程度者居多,职业分布以工人和农民为主。北京地区哮喘患者自诉其哮喘发作或加重时最严重的三种症状依次为：喘息、气急和胸闷；常见症状依次为：喘息、胸闷和咳嗽。31.9%的哮喘患者有吸烟史。哮喘患者合并过敏性鼻炎者占32.9%,合并湿疹者占9.3%,合并过敏性眼结膜炎者占5.5%,合并胃食管反流性疾病者占4.4%。
4.本调查的哮喘控制测试评分显示,北京地区34.9%患者达到了哮喘控制,39.2%处于部分控制,25.9%处于未控制。哮喘患者的控制水平较前有所提高,但与GINA指南所推荐的治疗目标尚存差距,急诊率和住院率仍处于较高水平。患者对疾病的认知和病情的自我监测程度仍然较低。哮喘控制不佳对患者日常活动和心理社会功能均造成了很大影响。应进一步加强哮喘患者的教育和管理,避免哮喘的致病因素和诱发因素、减少急性加重。指导患者长期规范化治疗从而提高患者生活质量、降低疾病负担。
Background
Bronchial asthma (asthma) is a chronic pulmonary disease in which many cells (eosinophils, mast cells, T lymphocytes, neutrophils, dendritic cells, airway epithelial cells) and cellular elements play an important role. The disorder of the airway is characterized by airway hyper responsiveness (AHR), airway inflammation, and airway remodeling. With the effect of industrialized and urbanization, climate change and environmental or ecology pollution, the prevalence rate and mortality of asthma are increasing year by year. Asthma is also a problem in China, with an estimated20million affected individuals. It not only reduces the quality life of individual but also brings the serious burden to the social economic and the family because of the great cost. Therefore, asthma has been the universal subject of prevention. Moreover, the factors that influence the risk of asthma are gradually changing with the ecology and lifestyle. So the epidemiology survey on prevalence and risk factors of asthma in different regions will make great significance on asthma prevention.
However, there is not much information on the epidemiological study of asthma in Beijing among the adults, especially lack of the effective prevention and treatment systems about it. The intervention measures and policy were not put into practice because of the deficiency of epidemiological survey data in Beijing. Then a comprehensive study was conducted to investigate the prevalence, risk factors, clinical feature, control level and reality of asthma. A collaboration of Beijing Health Bureau and China Asthma Alliance, provide an excellent platform to the epidemiological survey on prevalence rate and the associated risk factors of asthma in Beijing area (Projects in the Capital medical development scientific research). A cross-sectional study was carried out in this study (February2010to August2011) in Beijing residents among the people who aged more than14years. The multi-stage random cluster sampling methods was applied to obtain study subjects. In this report, the baseline data of the project was used. The author is one of the investigators of the project, responsible for coordination and inspection of the study field and data management and analysis.
Objective
1. To survey the prevalence rate and risk factors of bronchial asthma in Beijing area among the people who aged more than14years from2010to2011.
2. To obtain the clinical feature of asthmatic patients in Beijing area such as clinical syndromes, combinations, triggers and so on.
3. To evaluate the current level of asthma control and their insights and self-management from asthmatics and then assess the impaction on quality life of asthmatics.
Methods
1. Subjects:The people who aged more than14years in Beijing area were the target population of the study. And the objects were obtained by stratified cluster random sampling. The criterion of objects were as follow:(1) The age of the individual was more than14years, male or female;(2) People who had register of Beijing and lived here for no less than2years or those residents who had not registered of Beijing but lived here longer than3years.
2. Methods:From February2010to August2011, a cross-sectional study was carried out in this study. The multi-stage random cluster sampling methods was applied to obtain study subjects. The16districts and2counties of Beijing were classified in to three categories as urban (Dongcheng, Xicheng, Xuanwu and Chongwen), suburb (Haidian, Chaoyang, Shijingshan and Fengtai) and outskirt (Tongzhou, Mentougou, Daxing, Fangshan, Changping, Shunyi, Huairou, Pinggu, Miyun and Yanqing). Steps1,2districts or counties were randomly selected in each category. Step2, in each of the2selected districts or counties,1-2towns or street offices were randomly sampled as the target towns or street offices. Step3, in each of the1-2selected towns or street offices,1-2communities or villages were randomly sampled as the target communities or villages in each of the grade from grade1to grade4. Steps4, all of the residents in the selected communities or villages were sampled. Every districts or counties were sampled20000, and the total sample size was about60000.
Home visit completion of epidemiological questionnaires was conducted. And the asthmatics were diagnosed based upon case history, clinical signs and lung function test. Then the epidemiological status of Beijing area on prevalence and risk factors were investigated. Detailed epidemiology data on asthma control and reality was collected via face-to-face home visit interviews among the asthmatics so the control level and of asthma was investigated. All of the epidemiological questionnaires were collected and checked. Then they were coded and filed. At last, the questionnaires and their codes were input and checked by the professional person twice so that the data could correctly input.
3. Statistical Analysis:The version3.1of Epidata system was used for data entry and the data were analyzed using SAS9.2software package. The General social characteristics of all the participants were described. Minium, Maximum, Means and standard errors were calculated for measurement data. And prevalence rate, relative rate and constituent ratio were calculated for numeration data. Analysis of variance or nonparametric statistics were used to compare statistical differences of variables. Chis-square test or trend chi-square was used to compare statistical differences of prevalence rates. A2-tailed P value less than0.05was considered statistically significant.
Results
1. In total, sampling population was61107and57647questionnaires were valid actually. Of which687had asthma. Male asthmatics were296and female asthmatics were391. The overall prevalence rate was1.19%(687/57647). The asthma prevalence rates in urban and suburb of Beijing area were1.09%(418/38468) and1.40%(269/19179) respectively and the prevalence rate of asthma in suburb area was significantly higher than that of urban area (χ2=10.850, P=0.001). The asthma prevalence rates in male and female were1.06%(296/27947) and1.32%(391/29700) respectively and the prevalence rate of asthma in female was much higher than that of male (χ2=8.098, P=0.004). There was a significant difference among different age groups (χ2=404.874, P <0.005). The asthma prevalence rates in urban and suburb of Beijing area were highly increased by1.12and2.26times respectively than that of2002.
2. The risk factors associated with asthma may be female, active smoking, obesity, combination of allergic rhinitis, diagnosis of pneumonia, bronchitis/bronchiolitis, tuberculosis, allergy rhinitis, eczema, and direct relatives diagnosed of asthma and living in the suburb.255asthmatics were attacked or aggravated by some triggers which accounted for37.1%in all asthma patients. Patients-reported asthma triggers were exposure to cold air (154/687), climate change (141/687), irritant gas (120/687), catching a cold (111/687), tired (75/687), exercise (67/687), stress or nervous (56/687) and smoking (55/687).
3. A total of687asthmatic patients were detected in this survey with a mean age of (60.7±16.5) years and disease duration of (20.8±17.3) years.198asthmatics were first diagnosed in this survey which accounted for28.8%(198/687) in all asthma patients that were diagnosed in the survey.15.0%(103/687) asthmatics were diagnosed as asthma when they were in their childhood before14years. The severe symptoms that the asthmatics self-reported when they episodes were wheeze (383/687), shortness of breath (167/687) and dyspnea (154/687). The predominant symptoms that the asthmatics self-reported were wheeze (557/687) followed by dyspnea (497/687) and cough (484/687). The smoking rate of asthmatic patients was31.9%(219/687). The asthmatics who had a complication of allergic rhinitis, eczema, allergy conjunctivitis or GRED were accounted for32.9%,9.3%,5.5%and4.4%respectively.
4. In this study, according to the ACT test,34.9%(240/687) of the asthmatics in Beijing area had complete control,39.2%(269/687) had partially control and25.9%(178/687) had poorly controlled asthma. In the past year,21.3%(146/687) of patients reported emergency room visit at least one time within the past year due to asthma exacerbation and14.0%(96/687) had been hospitalized because of sudden attacks.13.5%(93/687) of the asthmatics knew that the intrinsic feature of asthma was inflammation and5.1%(104/687) of the asthmatics understood the treatment goal of this disease. Only12.1%(83/687) patients used inhaled corticosteroids regularly.71.2%(489/687) asthmatics had never undergone a lung functional test in the past year.12.3%(84/687) had a device for peak flow meter of their own but only1.5%(10/687) monitored peak flow regularly.46.6%(320/687) asthmatics reported that their activities including entertainment, learning, fertility and employment were limited due to asthma, Even3.6%(25/687) had mind of suicide.
Conclusions
1. The prevalence rate of asthma in urban and suburb are highly increased than ten years ago and it posed urgent situation to us. The prevalence rate of asthma in suburb area was significantly higher than that of urban area and the prevalence rate of asthma in female was much higher than that of male. There are significant different prevalence rates between different ages, occupations and education level but There is no differences between Han and Non-Han race.
2. There are many kinds of associated risk factors of asthma. Host factors such as atopy, sex, obesity and environmental factors included history of smoking, respiratory tract infection disease in childhood included pneumonia, bronchitis/bronchiolitis, tuberculosis and living in the suburb.255asthmatics were attacked or aggravated by some triggers which accounted for37.1%in all asthma patients. Patients-reported asthma triggers were exposure to cold air, climate change irritant gas, catching a cold, tired, exercise, stress or nervous and smoking.
3.687asthmatics were detected and198asthmatics were first diagnosed in this survey which accounted for28.8%in all asthma patients that were diagnosed in the survey. The severe symptoms that the asthmatics self-reported when they episodes were wheeze, shortness of breath and dyspnea The predominant symptoms that the asthmatics self-reported were wheeze followed by dyspnea and cough. The asthmatic patients who had history of smoking was accounted for31.9%. The asthmatics who had a complication of allergic rhinitis, eczema, allergy conjunctivitis or GRED were accounted for32.9%,9.3%,5.5%and4.4%respectively.
4. In this study,34.9%of the asthmatics in Beijing area had complete control,39.2%had partially control and25.9%had poorly controlled asthma. The level of asthma control in Beijing area has been improved greatly but it still falls down far below the GINA goals and there were also many times of emergency room visits and hospitalizations of asthmatics in Beijing area in the last year. The level of self-monitoring and insight about the disease among the asthmatics were very low. Activity limited, psychological and social functions were largely impacted by the disease because of the uncontrolled asthma. Therefore it is necessary to educate the asthmatics, guide the patients to the long-term management and standardized therapy and avoid the cause and the triggers of asthma. And then the times of exacerbations of asthma would be reduced and thus the life quality of asthmatics would be improved and the burden of this disease on society would be reduced.
引文
1. 林江涛,殷凯生.哮喘防治新进展专题笔谈[M].北京：人民卫生出版社,2008,1-7.
2. Adam RJ, Fuhlbrigge A, Guibert T, et al. Inadequate use of asthma medication in the United States:results of the asthma in America national population survey [J]. J Allergy Clin Immunol, 2002,110:58-64.
3. Chapman KR, Ernst P, Grenville A, et al. Control of asthma in Canada:failure to achieve guideline targets [J]. Can Respir J,2001,8(Suppl A):35-40.
4. Rabe KF, Vermeire PA, Soriano JB, et al. Clinical management of asthma in 1999:the asthma Insights and Reality in Europe (AIRE) study [J]. Eur Respir J,2000,16:802-807.
5. Lai CK, De Guia TS, Kim YY, et al. Asthma control in the Asia-Pacific region:The Asthma Insights and Reality in Asia-Pacific Study [J]. J Allergy Clin Immunol,2003,111:263-268.
6. Adachi M, Morikawa A, Ishihara K, Asthma insights and reality in Japan [J]. Allergy,2002, 51(5):411-420.
7. Adachi M, Ohta K, Morikawa A, et al. Asthma insights and reality in Japan 2005[J]. Allergy, 2006.55(10):1340-1343.
8. Hamid Q, The asthma insights and reality in Saudi Arabia (AIRSA) study [J]. Riyadh:Ministry of Health of the kingdom of Saudi Arabia; 2008.
9. Al-Busaidi N, Soriano JB. Asthma control in Oman:National Results within the Asthma Insights and Reality in the Gulf and the Near East (AIRGNE) Study [J]. Sultan Qaboos Univ Med J,2011, 11(1):45-51.
10. Neffen H, Fritscher C, Schacht FC, et al. Asthma control in Latin America (AIRLA) survey [J]. Pan Am J Public Health,2005,17(3):191-197.
11. Marks GB, Abramson MJ, Jenkins CR, et al. Asthma management and outcomes in Australia:a nation-wide telephone interview survey [J]. Respirology,2007,12(2):212-219.
12. Sekerel BE, Gemicioglu B, Soriano JB, et al. Asthma insights and reality in Turkey (AIRET) study [J]. Respir Med,2006,100(10):1850-1854.
13. Nafti S, Taright S, El Ftouh M. et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb (AIRMAG) study [J]. Respir Med,2009,103 Suppl 2:S2-11.
14. Hassan Mahboub BH, Santhakumar S, Soriano JB, et al. Asthma insights and reality in the United Arab Emirates [J]. Ann Thorac Med,2010,5(4):217-221.
15. Akinbami LJ, Moorman JE, Garbe PL, et al. Status of childhood asthma in the Untied States. 1980-2007 [J]. Pediatrics,2009,123(Suppl 3):S131-145.
16.柏娟,赵京,申昆玲,等.北京、重庆、广州三城市儿童哮喘患病情况调查[J].中华临床免疫和变态反应杂志,2010,4：280-284.
17. Al Ghobain MO, Al-Hajjai MS, Al Moamary MS. Asthma prevalence among 16 to 18 year old adolescents in Saudi Arabia using the ISAAC questionnaire [J]. BMC Public Health,2012, 12:239.
18. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,19(12):204.
19.周庆涛,贺蓓.1966年以来成人哮喘患病率增高可能与对哮喘的认知和诊断有关[J].中华医学杂志,2010,90：852.
20. National Institute of Health (NIH). National Heart, Lung and Blood Insitiute (NHLBI) /World Health Organization (WHO). Global strategy for asthma management and prevention. Global Initiative for asthma. United States:NIH Publication,2011,1-124.
21. Can Guideline-defined Asthma Control Be Achieved? The Gaining Optimal Asthma Control Study [J]. Am J Respir Crit Care Med,2004,170:836-844.
22. Kotwani A, Shendge S. Asthma self-management:a study in an emergency room of a chest hospital in delhi, India [J]. South Med Rev,2012,5(2):20-25.
23.赵学琴.保定成人哮喘现状调查及C-反应蛋白、IL-8对哮喘病情评估价值研究[D].河北：河北医科大学,2009.
24.娄晓宇,吴洁,胡红等.北京地区部分哮喘患者症状控制现状的初步调查[J].中国康复理论与实践,2007,13(5)：488-489.
25.潘颖.呼和浩特市14岁以上支气管哮喘患者治疗现状调查分析[D].内蒙古：内蒙古医学院,2007.
26.中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗和管理方案)[J].中华结核和呼吸杂志,2008,31：177-185.
27.王国斌,彭义利,杜长梅,等.河南省支气管哮喘患病率调查[J].中华结核和呼吸杂志,2002,25：25-28.
28.陈萍,于润江,候显明,等.辽宁省支气管哮喘流行病学调查[J],中华结核和呼吸杂志,2002,25(10)：603-606.
29.钱娟娟,马佳韵,周敏,等.上海市宝山区支气管哮喘患病率和危险因素调查[J].内科理论与实践,2011,6：121-124.
30. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,12:204.
31.林耀广,王辰,林江涛,等.北京地区职业人群支气管哮喘及其相关病症的患病率调查[J].中华结核和呼吸杂志,2002,25：650-654.
32.王辰,黄克武,童朝晖,等.北京地区化工职业人群哮喘流行病学调查及治疗现状[J].中华医学杂志,2001,81：1493-1495.
33.何权瀛,马艳良,张荣葆,等.我国常见慢性呼吸病城乡差别的研究[J].中华流行病学杂志,2006,27：459-460.
34. Ronmark EP, Ekerljung L, Lotvall J, et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166:1301-1308.
35. Lundback B. Epidemiology of rhinitis and asthma [J]. Clin Exp Allergy,1998,28 Suppl 2: S3-S10.
36. Leynaert B, Sunyer J, Garcia-Esteban R, et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma:a population-based cohort [J]. Thorax,2012,67: 625-631.
37. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,12:204.
38. Tollefsen E, Langhmmer A, Romundstad P, et al. Female gender is associated with higher incidence and more stable respiratory symptoms during adolescence [J]. Respir Med,2007,101: 896-902.
39.赵芝焕,郑荣,杨丽芬等.云南省支气管哮喘流行病学调查[J].昆明医学院学报,2008,29(3)：66-70.
40. Takeda M, Tanabe M, Ito W, et al. Gender difference in Allergic remodeling and immunoglobulin production in mouse model of asthma [J]. Respirology,2013, Mar 12.
41.丁毅鹏,姚红霞,汤小兰,等.2003年至2007年海南黎族支气管哮喘患病率调查[J].中华医学杂志,2010,90(44)：3112-3114.
42.陈萍,谢华,吴志家,等.辽宁省大中城市及郊区老年人支气管哮喘患病率调查[J].中华老年医学杂志,2004,23：109-111.
43. Tsai CL, Delclos GL, Huang JS, et al. Age-related differences in asthma outcomes in the United States,1988-2006 [J]. Ann Allergy Asthma Immunol,2013,110(4):240-246.
44. Ekerljung L, Sundblad BM, Ronmark E, et al. Incidence and prevalence of adult asthma is associated with low socio-economic status [J]. Clin Respir J,2010,4:147-156.
45. Michelle K. McHugh, Elaine Symanski, Lisa A. Pompeii, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am. J. Ind. Med,2010,53:463-475.
46. McHugh MK, Symanski E, Pompeii LA, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am J Ind Med,2010,53:463-475.
47. Centers for Disease Control and Prevention (CDC). Work-related asthma--38 states and District of Columbia,2006-2009[J]. MMWR Morb Mortal Wkly Rep,2012,61:375-378.
48. Pinto LA, Stein RT, Kabesch M. Impact of genetics in childhood asthma [J]. J Pediatr (Rio J), 2008,84(4 Suppl):S68-75.
49. Ronmark EP, Ekerljung L, Lotvall J. et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166(6):1301-1308.
50. Barnes KC. Evidence for common genetic elements in allergic disease [J]. J Allergy Clin Immunol,2000,106(5 Suppl):S192-S200.
51. Visness CM, London SJ, Daniels JL, et al. Association of childhood obesity with atopic and nonatopic asthma:results from the National Health and Nutrition Examination Survey 1999-2006 [J]. J Asthma,2010,47(7):822-829.
52. Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma:a cohort study of 118 723 males and females [J]. Eur Respir J,2010,35(6):1235-242.
53. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies [J]. Am J Respir Crit Care Med,2007,175(7):661-666.
54. Camarqo CA Jr, Sutherland ER, Bailey W, et al. Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans [J]. Curr Med Res Opin,2010,26(7):1629-1635.
55. Von Behren J, Lipsett M, Horn-Ross PL,et al. Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort [J]. Thorax,2009,64(10):889-893.
56. Leone N, Courbon D, Berr C, et al. Abdominal obesity and late-onset asthma:cross-sectional and Longitudinal Results:The 3C study[J]. Obesity (Silver Spring),2012,20(3):628-635.
57. A Sherriff, A Maitra, A R Ness, et al. Association of duration of television viewing in early childhood with the subsequent development of asthma [J]. Thorax,2009,64(4):321-325.
58. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy:systematic review and meta-analysis [J]. J Allergy Clin Immunol.2011; 127(3): 724-733.
59. Moreira A, Bonini M, Gaicia-Larsen V, et al. Weight loss interventions in asthma:EAACI Evidence-Based Clinical Practice Guideline (Part Ⅰ) [J]. Allergy,2013,68(4):425-439.
60. James KM, Peebles RS Jr, Hartert TV. Response to infections in patients with asthma and atopioc disease:An epiphenomenon or reflection of host susceptibility? [J]. J Allergy Clin Immunol, 2012,30(2):343-351.
61. Kim EY, Battaile JY, Patel AC, et al. Persistent activation of an innate immune response translates respiratory viral infection into chronic lung disease [J]. Nat Med,2008,14:633-640.
62. Nakamura K, Nagata C, Fujii K, et al. Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women [J]. Ann Allergy Asthma Immonol,2009,102(4):288-293.
63. Siroux V, Pin I, Oryszczyn MP, et al. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of asthma [J]. Eur Respir J,2000,15(3):470-477.
64. Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze:systematic review and meta-analysis [J]. Pediatric,2012,129(4):735-744.
65. Xepapadaki P, Manios Y, Liarigkovinos T, et al. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children [J]. Pediatr Allergy Immunol,2009,20(5):423-429.
66. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
67. Tan NC, Nqoh SH, Teo SS, et al. Impact of cigarette smoking on symptoms and quality of life of adults with asthma managed in public primary care clinics in Singapore:a questionnaire study [J]. Prim Care Respir J,2012,21(1):90-93.
68.蔡柏蔷,李龙芸主编.协和呼吸病学[M],2版.北京：中国协和医科大学出版社,1119-1120.
69. Oguzu lgen IK, Kervan F, Ozis T, et al. The impact of bronchiectasis in clinical presentation of asthma [J]. Southern medical journal,2007,100:468-471.
70. Chun TH, Weitzen SH, Fritz GK. The asthma/mental health nexus in a population-based sample of the United States [J]. Chest,2008,134(6):1176-1182.
71.方积乾.主编.生物医学研究的统计方法[M].北京.高等教育出版社,2011,264-265.
72. Partridge MR, van der Molen T, Myrseth SE, et al. Attitudes and actions of asthma patients on regular maintenance therapy:the INSPIRE study [J]. BMC Pulm Med,2006,6:13.
73.刘又宁,王辰,康健,等.呼吸内科学高级教程[M].北京.人民军医出版社,2010,224.
74. Mario Castro, Moncia Kraft. Clinical Asthma [M]. Mosby, an imprint of Elsevier Inc, China. 2008,1-12.
75.陈欣,林江涛.老年性哮喘诊治中应注意的问题[J].中华哮喘杂志(电子版),2007,1(2)：65-68.
76.袁媛.支气管哮喘患者控制现状和疾病认知程度调查[D].沈阳：中国医科大学,2010.
77.张洋洋.石家庄市城区哮喘患者控制现状及其影响因素的多因素分析[D].河北：河北医科大学,2008.
78. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
79.周涵,程雷,ARIA工作组.变应性鼻炎及其对哮喘的影响(ARIA)指南十年回顾与展望[J].中华耳鼻喉头颈外科杂志,2012,47(8)：619-622.
80.钟南山.我国支气管哮喘防治研究重点及努力方向[J].中华结核和呼吸杂志,2005,28(12)：809-811.
81. Occult sinusitis mey be a key feature for non-controlled asthma in children [J]. J Biol Regul Homeost Agents,2012,26(1 Suppl):S 125-31.
82. Bousquet J, Schunemann HJ, Samolinski B, et al. Allergic Rhinitis and its Impact on Asthma (ARIA):Achievements in 10 years and future needs [J]. J Allergy Clin Immunol,2012,30(5): 1049-1062.
83. Torgerson DG, Ampleford EJ, Chiu GY, et al. Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations [J]. Nat Genet,2011,43(9): 887-892.
84. Ozcan C, Erkocoqlu M, Civelek E, et al. The relationship between gastro-oesophageal reflux disease and asthma during childhood [J]. Allergy Immunopathol (Madr),2012, Dec 18.
85. Komatsu Y, HoppoT, Jobe BA. Et al. Proximal reflux as a cause of adult-onset asthma:the case for hypopharyngeal impedance testing to improve the sensitivity of diagnosis [J]. JAMA Surg, 2013,148(1):50-58.
86.林江涛.难治性哮喘的危险因素[J].中华哮喘杂志(电子版),2010,4(1)：1-3.
87. Kilic M, Ozturk F, Kirmemis O, et al. Impact of larygopharyngeal and gastroesophageal reflux on asthma control in children [J]. Int J Pediatr Otorhinolarygol,2013,77(3):341-345.
88.张庆宪,汤兵祥,彭义利.哮喘与肺结核的关系探讨[J].中国防痨杂志,2002,24(5)：267-269.
89. Athanazio R. Airway disease:similarities and differences between asthma, COPD and bronchiectasis. Clinics (Sao Paulo),2012,67(11):1335-1343.
90. Truong T. The overlap of bronchiectasis and immunodeficiency with asthma [J]. Immunol Allergy Clin North Am,2013,33(1):61-78.
91.林江涛,何权瀛,姚婉贞,等.北京市城区支气管哮喘患者的控制现状及对疾病认知程度的调查[J].中华结核和呼吸杂志,2007,30(7)：494-497.
92.苏楠,迟春花,董秀文,等,北京市城区门诊哮喘患者控制现状及疾病认知程度的调查分析[J].中华医学杂志,2009,89(8)：529-531.
93. Lich KH, Travers D, Psek W, et al. Emergency department visits attributable to asthma in North Carolina,2008[J]. N C Med J,2013,74(1):9-17.
94. Demoly P, Annunziata K, Gubba E, et al. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years [J]. Eur Respir Rev,2012,21(123):66-74.
95. Dalcin PT, Menegotto DM, Zanonato A, et al. Factors associated with uncontrolled asthma in Porto Alegre, Brazil [J]. Braz J Med Biol Res.2009,42(11):1097-1103.
96. Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations:insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) study [J]. Ann Allergy Asthma Immunol,2010,104(6):471-477.
97. Kirsch F, Teuner CM, Menn P, et al. Costs of illness for asthma and COPD in adults in Germany. Gesundheitswesen,2013, Apr 3.
98. Goral A, lipsitz JD, Muhsen K, et al. Depressive symptoms, risk factors and sleep in asthma: results from a national Israeli health survey [J]. Gen Hosp Psychiatry,2012,34(1):17-23.
1. 周庆涛,贺蓓.1966年以来成人哮喘患病率增高可能与对哮喘的认知和诊断有关[J].中华医学杂志,2010,90：852.
2. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in asthma prevalence, health care use, and mortality in the United States,2001-2010[J]. NCHS Data Brief,2012, (94):1-8.
3. Gershon AS, Guan J, Wang C, et al. Trends in Asthma prevalence and incidence in Ontario, Canada,1996-2005:a population study [J]. Am J Epidemiol,2010,172(6):728-736.
4. 全国儿童哮喘防治协作组.中国城区儿童哮喘患病率调查[J].中华儿科杂志,2003, 41：123-127.
5. 林江涛,殷凯生.哮喘防治新进展专题笔谈[M].北京.人民卫生出版社,2008,1-7.
6. Aiz, Dirks CG, Ulrik CS, et al. Long-term mortality among adults with asthma:A 25-year follow-up of 1075 out patients with asthma [J]. Chest,2013,12-2289.
7. 钟南山.支气管哮喘一基础与临床[M].北京：人民卫生出版社,2006,15.
8. 汤泰秦,丁勇,郑劲平,等.广东省支气管哮喘流行病学调查分析[J],中华结核和呼吸杂志,2000,23：730-733.
9. 王国斌,彭义利,杜长海,等.河南省支气管哮喘患病率调查[J],中华结核和呼吸杂志,2002,25：25-28.
10.陈萍,于润江,候显明,等.辽宁省支气管哮喘流行病学调查[J],中华结核和呼吸杂志,2002,25(10)：603-606.
11.钱娟娟,马佳韵,周敏,等.上海市宝山区支气管哮喘患病率和危险因素调查[J].内科理论与实践,2011,6：121-124.
12.丁逸鹏,姚红霞,汤小兰等.2003至2007年海南黎族支气管哮喘患病率调查[J].中华医学杂志,2012,90(44)：3112-3114.
13.刘同赏,姜涛,薛卫林等.青岛市城区成年人哮喘病因和控制情况分析[J].中国医师进修杂志,2011,34(z2)：3-5.
14.高芬,杨庆娟,张海国.2006至2007年青海省支气管哮喘患病率调查[J].中华结核和呼吸杂志,2011,34(3)：165-168.
15.陈萍.加强支气管哮喘的流行病学研究[J].中华内科杂志,2001,40(7)：433-434.
16. Pinto LA, Stein RT, Kabesch M. Impact of genetics in childhood asthma [J]. J Pediatr (Rio J),2008,84(4 Suppl):S68-75.
17. Haller G, Torgerson DQ Ober C, et al. Sequencing the IL-4 locus in African American implicates rare noncoding variants in asthma susceptibility [J]. J Allergy Clin Immunol, 2009,124(6):1204-1209.
18. Rogers AJ, Raby BA, Lasky-Su JA, et al. Assessing the reproducibility of asthma candidate gene associations, using genome-wide data [J]. Am J Respir Crit Med, 2009,179(2):1084-1090.
19. Finkelstein Y, Boumissen FG, Hutson JR, et al. Polymorphism of the ADRB2 gene and response to inhaled beta-agonists in children with asthma:a meta-analysis [J]. J Asthma, 2009,46(9):900-905.
20. Wenzel SE, Balzars, Ampleford E, et al. IL4R alpha mutations are associated with asthma exacerbations and mast cell/IgE expression [J]. Am J Respir Crit Care Med,2007,175(6): 570-576.
21. Loza MJ, Chang BL. Association between Q551R ILAR genetic variants and atopic asthma risk demonstrated by meta-analysis [J]. J Allergy Clin Immunol,2007,120(3): 578-585.
22. Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis [J]. Nat Genet,2006,38(4):441-446.
23. Lima JJ, Mohapatra S, Feng H, et al. A polymorphism in the NPPA gene associates with asthma [J]. Clin Exp Allergy,2008,38(7):1117-1123.
24. Sharma M, Batra J, Mabalirajan U, et al. A genetic variation in inositol polyphosphate 4 phosphatasea enhances susceptibility to asthma [J]. Am J Respir Crit Care Med,2008, 177(7):712-719.
25. Reijmerink NE, Kerkhof M, Koppelman GH, et al. Smoke exposure interacts with ADAM33 polymorphisms in the development of lung function and hyperresponsiveness [J]. Allergy,2009,64(6):898-904.
26. Blakey JD, Sayers I, Ring SM, et al. Positionally cloned asthma susceptibility gene polymorphisms and disease risk in the British 1958 Birth Cohort [J]. Thorax,2009,64(5): 381-387.
27. White JH, Chiano M, Wigglesworth M, et al. Identification of a novel asthma susceptibility gene on chromosome lqter and its functional evaluation [J]. Hum Mol Genet,2008,17(13):1890-1903.
28. Moffatt MF, Kabesch M, Liang L, et al. Genetic variants regulating ORMDL3 expression contribute to the risk of childhood asthma [J]. Nature,2007,448(7152):470-473.
29. Chupp GL, Lee CG, Jarjour N, et al. A chitinase-like protein in the lung and circulation of patients with severe asthma [J]. N Engl J Med,2007,357(20):2016-2027.
30. Rathche CN, Holmlkvist J, Husmoen LL, et al. Association of polymorphisms of the CH13L1 gene with asthma and atopy:a populations-based study of 6514 Danish adults [J]. PLoS One,2009,4(7):e6106.
31. Pearce N, Pekkanen J, Beasley R. How much asthma is really attributable to aotpy? [J]. Thorax,1999,54(3):268-272.
32. Ronmark EP, Ekerljung L, Lotvall J. et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166(6):1301-1308.
33. Martinez FD. Viruses and atopic sensitization in the first years of life [J]. Am J Respir Crit Care Med,2000,162(3 Pt 2):S95-99.
34. Barnes KC. Evidence for common genetic elements in allergic disease [J]. J Allergy Clin Immunol,2000,106(5 Suppl):S192-S200.
35. van den Nieuwenhof L. Schermer T. Bosch Y, et al. Is physician-diagnosed allergic rhinitis a risk factor for the development of asthma? [J]. Allergy,2010,65(8):1049-1055.
36. Shaaban R, Zureik M, Soussan D, et al. Rhinitis and onset of asthma:a longitudinal population-based study [J]. Lancet,2008,372(9643):1049-1057.
37. Zhao J, He Q, Zhang G, et al. Status of asthma control in children and the effect of parent' knowledge, attitude, and practice (KAP) in China:a multicenter study [J]. Ann Allergy Asthma Immunol,2012,109(3):190-194.
38. Postma DS, Bleecker ER, Amelug PJ, et al. Genetic susceptibility to asthma-bronchial hyperresponsiveness coinherited with a major gene for atopy [J]. N Engl J Med,1995, 333(14):894-900.
39. van den Nieuwenhof L, Schermer T, Heijdra Y, et al. Are asymptomatic airway hyperresponsiveness and allergy risk factors for asthma? A longitudinal study [J]. Eur Respir J,2008,32(1):70-76.
40. Liang KL, Jiang RS, Wang RC, et al. Upper airway inflammation exacerbates bronchial hyperreactivity in mouse models of rhinosinusitis and allergic asthma. Int Forum Allergy Rhinol[J].2013, Mar 4.
41. Lipma G, Matusovsky O, Lauzon AM. Accumulating evidence for increased velocity of airway smooth muscle shortening in asthmatic airway hyperresponsiveness [J]. J Allergy (Cairo),2012, Dec 25.
42. Munoz-Lopez F. Bronchial hyperresponsiveness and asthma in the pediatric population [J]. Allergy Immunopathol (Madr),2013, Mar 12.
43. Leynaert B, Sunyer J, Garcia-Esteban R, et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma:a population-based cohort [J]. Thorax, 2012,67:625-631.
44. Gissler M, Jarvelin MR, Louhiala P, et al. Boys have more health Problems in childhood than girls; follow-up of the 1987 finish birth cohort [J]. Acta pediatr,1999,88(3): 310-314.
45. Sears MR, Burrows B, Flannery EM, et al. Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma [J]. Clin Exp Allergy,1993,23(11): 941-948.
46. Macsali F, Real FG, Omenaas ER. et al. Oral contraception, body mass index, and asthma: a cross-secional Nordic-Baltic population survey[J]. J Allergy Clin Immunol,2009,123(2): 391-397.
47. Nafti S, Taright S, El Ftouh M, et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb (AIRMAG) study [J]. Respir Med,2009,103 Suppl 2: S2-S11.
48.刘国梁,林江涛.肥胖与哮喘[J].中华医学杂志,2009,(89)：512.
49. Visness CM, London SJ, Daniels JL, et al. Association of childhood obesity with atopic and nonatopic asthma:results from the National Health and Nutrition Examination Survey 1999-2006 [J]. J Asthma,2010,47(7):822-829.
50. Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma:a cohort study of 118 723 males and females [J], Eur Respir J,2010,35(6):1235-242.
51. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies [J]. Am J Respir Crit Care Med,2007,175(7):661-666.
52. Farah CS, Kermode JA, Downie SR, et al. Obesity is a determinant of asthma control independent of information and lung mechanics [J]. Chest,2011,140(3):659-666.
53. Camarqo CA Jr, Sutherland ER, Bailey W, et al. Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans [J]. Curr Med Res Opin,2010,26(7):1629-1635.
54. Von Behren J, Lipsett M, Horn-Ross PL,et al. Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort [J]. Thorax,2009,64(10):889-893.
55. Leone N, Courbon D, Berr C, et al. Abdominal obesity and late-onset asthma: cross-sectional and Longitudinal Results:The 3C study[J]. Obesity (Silver Spring),2012, 20(3):628-635.
56. A Sherriff, A Maitra, A R Ness, et al. Association of duration of television viewing in early childhood with the subsequent development of asthma [J]. Thorax,2009,64(4):321-325.
57. Fenger RV, Gonzalez-Quintela A, Linneberg, et al. the relationship of serum triglycerides, serum HDL, and obesity to the risk of wheezing in 85,555 adults [J], Respir Med,2013, Mar 3.
58. Kim Y, Jo EJ, Kang SY, et al. Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma [J]. Ann Allergy Asthma Immunol,2013,110(4); 253-257.
59. Teodorescu M, Polomis DA, Teodorescu MC, et al. Association of obstructive sleep apnea risk or diagnosis with daytime asthma in adults [J]. J Asthma,2012,49(6):620-628.
60. Weqienka G, Joseph CL, Havstad S, et al. Sensitization and allergic histories differ between black and white pregnant women [J]. J Allergy Clin Immunol,2012,130(3): 657-662.
61. Weqienka G, Havstad S, Joseph CL, et al. Allergic sensitization frequency and wheezing differences in early life between black and white children [J]. Allergy Asthma Proc,2012, 33(6):493-499.
62. Winer RA, Qin X, Harrington T. et al. Asthma incidence among children and adults: findings from the Behavioral Risk Factor Surveillance system asthma call-back survey-United States,2006-2008 [J]. J Asthma,2012,49(1):16-22.
63. Zahran HS, Bailev C. Factors associated with asthma prevalence among racial and ethnic groups-United States,2009-2010 Behaviroral Risk Factor Surveillance System [J]. J Asthma,2013, Apr 11.
64. Oraka E, Iqbal S, Flanders WD, et al. Racial and Ethnic Disparities in current asthma and emergency department visits:Findings from the National Health Interview Survey, 2001-2010[J]. J Asthma,2013, Apr 2.
65. Holgate ST. The epidemic of allergy and asthma [J]. Nature,1999,402:2-4.
66. Custovic A, Simpson A. The role of inhalant allergens in allergic airways disease [J]. J Investig Allergol Clin Immunol,2012,22(6):393-401.
67. Rauh VA, Chew GR, Garfinkel RS. Deteriorated housing contributes to high cickriach allergen levels in inner-city households [J]. Environ Health Perspect,2002,110(Suppl.2): 323-327.
68. Thomas B, Heap P, Carswell F. Ultrastructural localization of the allergen Der p I in the gut of the house dust mite Dermatophagoides pteronyssinus [J]. Int Arch Allergy Appl Immunol,1991,94:365-367.
69. Witteman AM, Akkerdaas JH, van Leeuwen J, et al. Identification of a cross-reactive allergen (presumably tropomyosin) in shrimp, mite and insects [J]. Int Arch Allergy Immunol,1994,105:56-61.
70. Tsai LC, Chao PL, Hung MW, et al. Protein sequence analysis and mapping of IgE and IgG epitopes of an allergenic 98-kDa Dermatohagoides farinae paramyosin [J]. Der f 11. Allergy,2000,55(2):141-147.
71. Carayol N, Birnbaum J, Magnan A, et al. Fel d I production in the cat skin varies according to anatomical sites [J]. Allergy,2000,55(6):570-573.
72. Chapman MD, Smith AM, Vailes LD, et al. Recombinant allergens for diagnosis and therapy of allergic disease [J]. J Allergy Clin Immunol,2000,106(3):409-418.
73. Platts-Mills T, Vauhan J, Squillace S, et al. Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen:a population-based cross-sectional study [J]. Lancet,2001,357(9258):752-756.
74. Kailasnath VP, Raj S, Sublett JL. Mouse allergen skin sensitization in asthmatic children of suburban, rural, and inner-city populations [J]. Allergy Asthma Proc,2013,34(2): 176-178.
75. Arruda LK, Chapman MD. The role of cockroach allergens in asthma [J]. Curr Opin Pulm Med,2001,7(1):14-19.
76. National Institute of Health (NIH). National Heart, Lung and Blood Insitiute (NHLBI) /World Health Organization (WHO). Global strategy for asthma management and prevention. Global Initiative for asthma. NIH Publication,2011,1-124.
77. James KM, Peebles RS Jr, Hartert TV. Response to infections in patients with asthma and atopioc disease:An epiphenomenon or reflection of host susceptibility? [J]. J Allergy Clin Immunol,2012,30(2):343-351.
78. Kim EY, Battaile JY, Patel AC, et al. Persistent activation of an innate immune response translates respiratory viral infection into chronic lung disease [J]. Nat Med,2008,14: 633-640.
79. Strachan D P. Hay fever, hygiene and household size [J]. BMJ,1989,299(6710): 1259-1260.
80. Lin AH, Leung DY. Renaissance of the hygiene hypothesis [J]. J Allergy Clin Immunol, 2006,117(5):1063-1066.
81.王红玉,陈育智,马渝,等.中国儿童哮喘患病率的地区差异与生活方式的不同有关[J].中华儿科杂志,2006,44(1)：41-45.
82. Schaub B, Lauener R, von Mutius E. The many faces of the hygiene hypothesis [J]. J Allergy Clin Immunol,2006,117(5):969-977.
83. Taube C, Muller A. The role of Helicobacter pylori infection in the development of allergic asthma [J]. Expert Rev Respir Med,2012,6(4):441-449.
84. Alm B, MD, Erdes L, Mollborg P. et al. Neonatal antibiotic treatment is a risk factor for early wheezing [J]. Pediatrics,2008,121(4):697-702.
85. Stanley J Szefler, Donald Y. M. Leung. Severe Asthma:Pathogenesis and Clinical Management [M]. New York:Marcel Dekker, Inc,2001,389-418.
86. Michelle K. McHugh, Elaine Symanski, Lisa A. Pompeii, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am. J. Ind, Med.2010,53: 463-475.
87. Centers for Disease Control and Prevention (CDC). Work-related asthma--38 states and District of Columbia,2006-2009[J]. MMWR Morb Mortal Wkly Rep,2012,61:375-378.
88. Eng A, T Mannetje A, Douwes J, et al. The New Zealand workforce survey Ⅱ:occupational risk factors for asthma [J]. Ann Occup Hyg,2010,54(2):154-164.
89.王雷,闫永健.职业性哮喘70例的职业特征[J].职业与健康,2008,24(9)：831-832.
90. Tagiyeva N, Devereux G, Semple S, et al. Parental occupation is a risk factor for childhood wheeze and asthma [J]. Eur Respir J,2010,35(5):987-993.
91. Frampton MW, Utell MJ, Zareba W, et alEffects of exposure to ultrafine carbon particles in healthy subjects and subjects with asthma[J]. Res Rep Health Eff Inst,2004, 12(126):1-47.
92. Penard-Morand C, Raherison C, Charpin D, et al. Long-term exposure to close-proximity air pollution and asthma and allergies in urban children [J]. Eur Respir J,2010,36(1): 33-40.
93. Baumann LM, Robinson CL, Combe JM, et al. Effects of distance from a heavily transited avenue on asthma and atopy in a periurban shantytown in Lima, Peru [J]. J Allergy Clin Immunol,2011,127(4):875-882.
94. Bernstein DI. Traffic-related pollutants and wheezing in children [J]. J Asthma,2012, 49(1):5-7.
95. Yeatts K, Svendsen E, Creason J, et al. Coarse particulate matter(PM 2.5-10) affects heart rate variability, blood lipids, and circulating eosinophils in adults with asthma[J]. Environ Health Perspect,2007,115(5):719-714.
96. Auten RL, Mason SN, Potts-Kant EN, et al. Early life Ozone exposure induces adult murine airway hyperresponsiveness through effects on airway permeability [J]. J Appl Physiol,2103,Apr 4.
97. Tong H, Rappold AG, Diaz-Sanchez D. Omega-3 fatty acid supplementation appears to attenuate particulate air pollution-induced cardiac effects and lipid changes in healthy middle-aged adults [J].Environ Health Perspect,2012,120(7):952-957.
98. Shea KM, Truckner RT, Weber RW, et al. Climate change and allergic disease [J]. J Allergy Clin Immunol,2008,122(3):443-453.
99. Pekkanen J, Hwarinen A, Haverinen-Shaughnessy U, et al. Moisture damage and childhood asthma:a population-based incident case-control study [J]. Eur Respir J,2007, 29(3):509-515.
100. Agrawal S. Effect of indoor air pollution from biomass and solid fuel combustion on prevalence of self-reported asthma among adult men and women in India:findings from a nationwide large-scale cross-sectional survey [J]. J Asthma,2012,49(4):355-365.
101. Annesi-Maesano I, Hulin M, Lavaud F, et al. Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study [J]. Thorax, 2012,67(8):682-688.
102. LU KD, Breysse PN, Diette GB, et al. Being overweight increases susceptibility to indoor pollutants among urban children with asthma [J]. J Allergy Clin Immunol,2013, S0091-6749.
103. Nakamura K, Nagata C, Fujii K, et al. Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women [J]. Ann Allergy Asthma Immonol,2009,102(4): 288-293.
104. Siroux V, Pin I, Oryszczyn MP, et al. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of asthma [J]. Eur Respir J,2000,15(3):470-477.
105. Wahlgren DR. Involuntary smoking and asthma [J]. Curr Opin Plum Med,2000,6:31-36.
106. Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze:systematic review and meta-analysis [J]. Pediatric,2012, 129(4):735-744.
107. Xepapadaki P, Manios Y, Liarigkovinos T, et al. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children [J]. Pediatr Allergy Immunol,2009,20(5):423-429.
108. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
109. Tan NC, Nqoh SH, Teo SS, et al. Impact of cigarette smoking on symptoms and quality of life of adults with asthma managed in public primary care clinics in Singapore:a questionnaire study [J]. Prim Care Respir J,2012,21(1):90-93.
110. Zaknun D, Schroecksnadel S, Kurz K, et al. Potential role of antioxidant food supplements, preservatives and colorants in the pathogenesis of allergy and asthma [J]. Int Arch Allergy Immunol,2012,157(2):113-124.
111. Scholtens S, Wijga AH, Brunekreef B, et al. Breast feeding, parental allergy and asthma in children followed for 8 years. The PLAMA birth cohort study [J]. Thorax,2009,64(7): 604-609.
112. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy:Systematic review and meta-analysis [J]. J Allergy Clin Immunol, 2011,127(3):724-733.
113. Torres-Borrego J, Moreno-Solis G, Molina-Teran AB. Diet for the prevention of asthma and allergies in early childhood:much do about something? [J]. Allergol Immunopathol (Madr),2012,40(4):244-252.
114. Wood L G, Gibson PG. Dietary factors lead to innate immune activation in asthma [J]. Pharmacol Ther,2009,123(1):37-53.
115. Maslova E, Strom M, Olsen SF,et al. Consumption of artificially-sweetened soft drinks in pregnancy and risk of child asthma and allergic rhinitis [J]. Epub, PloS One,2013,8(2): e57162.
116. Hsu NY, Wu PC, Bornehag CG, et al. Feeding bottles usage and the prevalence of childhood allergy and asthma [J]. Clin Dev Immunol,2012:158248.
117. Maslova E, Halldorsson TI, Strem M, et al. Low-fat yoghurt intake in pregnancy assoiciated with increased child asthma and allergic rhinitis risk:a prospective cohort study [J].J Nutr,2012,6:1.
118. Maslova E, Strom M, Olsen E, et al. Fish intake duringpregnancy and the risk of child asthma and allergic rhinitis longitudinal evidence from the Danish National Birth Cohort [J]. Br J Nutr,2013,8:1-13.
119. Gale CR, Robinson SM, Harvey NC, el al. Maternal vitamin D status during pregnancy and child outcomes [J]. Eur J Clin Nutr,2008,62:68-77.
120. Bener A, Ehlayel MS, Tulic MK, et al. Vitamin D deficiency as a strong predictor of asthma in children [J]. Int Arch Allergy Immunol,2012,157(2):168-175.
121. Erkkola M, Nwaru BI, Kaila M, et al. Risk of asthma and allergic outcomes in the offspring in relation to maternal food consumption during pregnancy:a Finish birth cohort study [J]. Pediatr Allergy Immunol,2012,23(2):186-194.
122. Brehm JM, Celedon JC, Soto-Quiros ME, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica [J]. Am J Respir Crit Care Med,2009,179(9): 765-771.
123. Crump C, Winkleby MA, Sundquist J, et al. Risk of asthma in young adults who were born preterm:a Swedish national cohort study[J]. Pediatrics,2011,127(4):e913-920.
124. Steffensen FH, Sorensen HT, Gillman MW, et al. Low birth weight and preterm delivery as risk factors for asthma and atopic dermatitis in young adult males[J]. Epidemiology,2000,11(2):185-188.
125. Tedner SG, Ortqvist AK, Almqvist C. et al. Fetal growth and risk of childhood asthma and allergic disease [J]. Clin Exp Allergy,2012,42(10):1430-1437.
126. Ekerljung L, Sundblad BM, Ronmark E, et al. Incidence and prevalence of adult asthma is associated with low socio-economic status [J]. Clin Respir J,2010,4(3):147-156.
127. Goldberg S, Israeli E, Schwartz S, et al. Asthma prevalence, family Size, and birth order [J]. Chest,2007,131(6):1747-1752.
128. Eijkemans M, Mommers M, Draaisma, et al. Physical activity and asthma:a systematic review and mata-analysis [J]. Epub PLouS One,2012,7(12):e50775.
129.张晓岩,林江涛.支气管哮喘发病的危险因素[J].中华哮喘杂志(电子版),2007,1(1)：1-4.
130. Genuneit J, Strachan DP, Bchele G, et al. The combined effects of family size and farm exposure on childhood hay fever and atopy [J]. Pediatr Allergy Immunol,2013, Apr 3.
131. Suqlia SF, Duarte CS, Sandel MT, et al. Social and environmental stressors in the home and childhood asthma [J]. J Epidemiol Community Health,2010,64(7):636-642.
132. Chun TH, Weitzen SH, Fritz GK. The asthma/mental health nexus in a population-based sample of the United States [J]. Chest,2008,134(6):1176-1182.
133. Milam J, McConnell R, Yao L, et al. Parental stress and childhood wheeze in a prospective cohort study [J]. J Asthma,2008,45(4):319-323.
134. Kozyrskyi AL, Mai XM, Mc Grath P, et al. Continued exposure to maternal distress in early life associated with an increased risk of childhood asthma [J]. Am J Respir Crit Care Med,2008,15(177):142-147.
135. Sandberg S, Jarvenpaa S, Penttinen A, et al. Asthma exacerbations in children immediately following stressful life events:a Cox's hierarchical regression [J]. Thorax, 2004,59(12):1046-1051.
136.钟南山.我国支气管哮喘防治研究重点及努力方向[J].中华结核和呼吸杂志,2005,28(12)：809-811.
2. Adam RJ, Fuhlbrigge A, Guibert T, et al. Inadequate use of asthma medication in the United States:results of the asthma in America national population survey [J]. J Allergy Clin Immunol, 2002,110:58-64.
3. Chapman KR, Ernst P, Grenville A, et al. Control of asthma in Canada:failure to achieve guideline targets [J]. Can Respir J,2001,8(Suppl A):35-40.
4. Rabe KF, Vermeire PA, Soriano JB, et al. Clinical management of asthma in 1999:the asthma Insights and Reality in Europe (AIRE) study [J]. Eur Respir J,2000,16:802-807.
5. Lai CK, De Guia TS, Kim YY, et al. Asthma control in the Asia-Pacific region:The Asthma Insights and Reality in Asia-Pacific Study [J]. J Allergy Clin Immunol,2003,111:263-268.
6. Adachi M, Morikawa A, Ishihara K, Asthma insights and reality in Japan [J]. Allergy,2002, 51(5):411-420.
7. Adachi M, Ohta K, Morikawa A, et al. Asthma insights and reality in Japan 2005[J]. Allergy, 2006.55(10):1340-1343.
8. Hamid Q, The asthma insights and reality in Saudi Arabia (AIRSA) study [J]. Riyadh:Ministry of Health of the kingdom of Saudi Arabia; 2008.
9. Al-Busaidi N, Soriano JB. Asthma control in Oman:National Results within the Asthma Insights and Reality in the Gulf and the Near East (AIRGNE) Study [J]. Sultan Qaboos Univ Med J,2011, 11(1):45-51.
10. Neffen H, Fritscher C, Schacht FC, et al. Asthma control in Latin America (AIRLA) survey [J]. Pan Am J Public Health,2005,17(3):191-197.
11. Marks GB, Abramson MJ, Jenkins CR, et al. Asthma management and outcomes in Australia:a nation-wide telephone interview survey [J]. Respirology,2007,12(2):212-219.
12. Sekerel BE, Gemicioglu B, Soriano JB, et al. Asthma insights and reality in Turkey (AIRET) study [J]. Respir Med,2006,100(10):1850-1854.
13. Nafti S, Taright S, El Ftouh M. et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb (AIRMAG) study [J]. Respir Med,2009,103 Suppl 2:S2-11.
14. Hassan Mahboub BH, Santhakumar S, Soriano JB, et al. Asthma insights and reality in the United Arab Emirates [J]. Ann Thorac Med,2010,5(4):217-221.
15. Akinbami LJ, Moorman JE, Garbe PL, et al. Status of childhood asthma in the Untied States. 1980-2007 [J]. Pediatrics,2009,123(Suppl 3):S131-145.
16.柏娟,赵京,申昆玲,等.北京、重庆、广州三城市儿童哮喘患病情况调查[J].中华临床免疫和变态反应杂志,2010,4：280-284.
17. Al Ghobain MO, Al-Hajjai MS, Al Moamary MS. Asthma prevalence among 16 to 18 year old adolescents in Saudi Arabia using the ISAAC questionnaire [J]. BMC Public Health,2012, 12:239.
18. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,19(12):204.
19.周庆涛,贺蓓.1966年以来成人哮喘患病率增高可能与对哮喘的认知和诊断有关[J].中华医学杂志,2010,90：852.
20. National Institute of Health (NIH). National Heart, Lung and Blood Insitiute (NHLBI) /World Health Organization (WHO). Global strategy for asthma management and prevention. Global Initiative for asthma. United States:NIH Publication,2011,1-124.
21. Can Guideline-defined Asthma Control Be Achieved? The Gaining Optimal Asthma Control Study [J]. Am J Respir Crit Care Med,2004,170:836-844.
22. Kotwani A, Shendge S. Asthma self-management:a study in an emergency room of a chest hospital in delhi, India [J]. South Med Rev,2012,5(2):20-25.
23.赵学琴.保定成人哮喘现状调查及C-反应蛋白、IL-8对哮喘病情评估价值研究[D].河北：河北医科大学,2009.
24.娄晓宇,吴洁,胡红等.北京地区部分哮喘患者症状控制现状的初步调查[J].中国康复理论与实践,2007,13(5)：488-489.
25.潘颖.呼和浩特市14岁以上支气管哮喘患者治疗现状调查分析[D].内蒙古：内蒙古医学院,2007.
26.中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗和管理方案)[J].中华结核和呼吸杂志,2008,31：177-185.
27.王国斌,彭义利,杜长梅,等.河南省支气管哮喘患病率调查[J].中华结核和呼吸杂志,2002,25：25-28.
28.陈萍,于润江,候显明,等.辽宁省支气管哮喘流行病学调查[J],中华结核和呼吸杂志,2002,25(10)：603-606.
29.钱娟娟,马佳韵,周敏,等.上海市宝山区支气管哮喘患病率和危险因素调查[J].内科理论与实践,2011,6：121-124.
30. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,12:204.
31.林耀广,王辰,林江涛,等.北京地区职业人群支气管哮喘及其相关病症的患病率调查[J].中华结核和呼吸杂志,2002,25：650-654.
32.王辰,黄克武,童朝晖,等.北京地区化工职业人群哮喘流行病学调查及治疗现状[J].中华医学杂志,2001,81：1493-1495.
33.何权瀛,马艳良,张荣葆,等.我国常见慢性呼吸病城乡差别的研究[J].中华流行病学杂志,2006,27：459-460.
34. Ronmark EP, Ekerljung L, Lotvall J, et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166:1301-1308.
35. Lundback B. Epidemiology of rhinitis and asthma [J]. Clin Exp Allergy,1998,28 Suppl 2: S3-S10.
36. Leynaert B, Sunyer J, Garcia-Esteban R, et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma:a population-based cohort [J]. Thorax,2012,67: 625-631.
37. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:findings from the cross-sectional world health survey [J]. BMC Public Health,2012,12:204.
38. Tollefsen E, Langhmmer A, Romundstad P, et al. Female gender is associated with higher incidence and more stable respiratory symptoms during adolescence [J]. Respir Med,2007,101: 896-902.
39.赵芝焕,郑荣,杨丽芬等.云南省支气管哮喘流行病学调查[J].昆明医学院学报,2008,29(3)：66-70.
40. Takeda M, Tanabe M, Ito W, et al. Gender difference in Allergic remodeling and immunoglobulin production in mouse model of asthma [J]. Respirology,2013, Mar 12.
41.丁毅鹏,姚红霞,汤小兰,等.2003年至2007年海南黎族支气管哮喘患病率调查[J].中华医学杂志,2010,90(44)：3112-3114.
42.陈萍,谢华,吴志家,等.辽宁省大中城市及郊区老年人支气管哮喘患病率调查[J].中华老年医学杂志,2004,23：109-111.
43. Tsai CL, Delclos GL, Huang JS, et al. Age-related differences in asthma outcomes in the United States,1988-2006 [J]. Ann Allergy Asthma Immunol,2013,110(4):240-246.
44. Ekerljung L, Sundblad BM, Ronmark E, et al. Incidence and prevalence of adult asthma is associated with low socio-economic status [J]. Clin Respir J,2010,4:147-156.
45. Michelle K. McHugh, Elaine Symanski, Lisa A. Pompeii, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am. J. Ind. Med,2010,53:463-475.
46. McHugh MK, Symanski E, Pompeii LA, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am J Ind Med,2010,53:463-475.
47. Centers for Disease Control and Prevention (CDC). Work-related asthma--38 states and District of Columbia,2006-2009[J]. MMWR Morb Mortal Wkly Rep,2012,61:375-378.
48. Pinto LA, Stein RT, Kabesch M. Impact of genetics in childhood asthma [J]. J Pediatr (Rio J), 2008,84(4 Suppl):S68-75.
49. Ronmark EP, Ekerljung L, Lotvall J. et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166(6):1301-1308.
50. Barnes KC. Evidence for common genetic elements in allergic disease [J]. J Allergy Clin Immunol,2000,106(5 Suppl):S192-S200.
51. Visness CM, London SJ, Daniels JL, et al. Association of childhood obesity with atopic and nonatopic asthma:results from the National Health and Nutrition Examination Survey 1999-2006 [J]. J Asthma,2010,47(7):822-829.
52. Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma:a cohort study of 118 723 males and females [J]. Eur Respir J,2010,35(6):1235-242.
53. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies [J]. Am J Respir Crit Care Med,2007,175(7):661-666.
54. Camarqo CA Jr, Sutherland ER, Bailey W, et al. Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans [J]. Curr Med Res Opin,2010,26(7):1629-1635.
55. Von Behren J, Lipsett M, Horn-Ross PL,et al. Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort [J]. Thorax,2009,64(10):889-893.
56. Leone N, Courbon D, Berr C, et al. Abdominal obesity and late-onset asthma:cross-sectional and Longitudinal Results:The 3C study[J]. Obesity (Silver Spring),2012,20(3):628-635.
57. A Sherriff, A Maitra, A R Ness, et al. Association of duration of television viewing in early childhood with the subsequent development of asthma [J]. Thorax,2009,64(4):321-325.
58. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy:systematic review and meta-analysis [J]. J Allergy Clin Immunol.2011; 127(3): 724-733.
59. Moreira A, Bonini M, Gaicia-Larsen V, et al. Weight loss interventions in asthma:EAACI Evidence-Based Clinical Practice Guideline (Part Ⅰ) [J]. Allergy,2013,68(4):425-439.
60. James KM, Peebles RS Jr, Hartert TV. Response to infections in patients with asthma and atopioc disease:An epiphenomenon or reflection of host susceptibility? [J]. J Allergy Clin Immunol, 2012,30(2):343-351.
61. Kim EY, Battaile JY, Patel AC, et al. Persistent activation of an innate immune response translates respiratory viral infection into chronic lung disease [J]. Nat Med,2008,14:633-640.
62. Nakamura K, Nagata C, Fujii K, et al. Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women [J]. Ann Allergy Asthma Immonol,2009,102(4):288-293.
63. Siroux V, Pin I, Oryszczyn MP, et al. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of asthma [J]. Eur Respir J,2000,15(3):470-477.
64. Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze:systematic review and meta-analysis [J]. Pediatric,2012,129(4):735-744.
65. Xepapadaki P, Manios Y, Liarigkovinos T, et al. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children [J]. Pediatr Allergy Immunol,2009,20(5):423-429.
66. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
67. Tan NC, Nqoh SH, Teo SS, et al. Impact of cigarette smoking on symptoms and quality of life of adults with asthma managed in public primary care clinics in Singapore:a questionnaire study [J]. Prim Care Respir J,2012,21(1):90-93.
68.蔡柏蔷,李龙芸主编.协和呼吸病学[M],2版.北京：中国协和医科大学出版社,1119-1120.
69. Oguzu lgen IK, Kervan F, Ozis T, et al. The impact of bronchiectasis in clinical presentation of asthma [J]. Southern medical journal,2007,100:468-471.
70. Chun TH, Weitzen SH, Fritz GK. The asthma/mental health nexus in a population-based sample of the United States [J]. Chest,2008,134(6):1176-1182.
71.方积乾.主编.生物医学研究的统计方法[M].北京.高等教育出版社,2011,264-265.
72. Partridge MR, van der Molen T, Myrseth SE, et al. Attitudes and actions of asthma patients on regular maintenance therapy:the INSPIRE study [J]. BMC Pulm Med,2006,6:13.
73.刘又宁,王辰,康健,等.呼吸内科学高级教程[M].北京.人民军医出版社,2010,224.
74. Mario Castro, Moncia Kraft. Clinical Asthma [M]. Mosby, an imprint of Elsevier Inc, China. 2008,1-12.
75.陈欣,林江涛.老年性哮喘诊治中应注意的问题[J].中华哮喘杂志(电子版),2007,1(2)：65-68.
76.袁媛.支气管哮喘患者控制现状和疾病认知程度调查[D].沈阳：中国医科大学,2010.
77.张洋洋.石家庄市城区哮喘患者控制现状及其影响因素的多因素分析[D].河北：河北医科大学,2008.
78. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
79.周涵,程雷,ARIA工作组.变应性鼻炎及其对哮喘的影响(ARIA)指南十年回顾与展望[J].中华耳鼻喉头颈外科杂志,2012,47(8)：619-622.
80.钟南山.我国支气管哮喘防治研究重点及努力方向[J].中华结核和呼吸杂志,2005,28(12)：809-811.
81. Occult sinusitis mey be a key feature for non-controlled asthma in children [J]. J Biol Regul Homeost Agents,2012,26(1 Suppl):S 125-31.
82. Bousquet J, Schunemann HJ, Samolinski B, et al. Allergic Rhinitis and its Impact on Asthma (ARIA):Achievements in 10 years and future needs [J]. J Allergy Clin Immunol,2012,30(5): 1049-1062.
83. Torgerson DG, Ampleford EJ, Chiu GY, et al. Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations [J]. Nat Genet,2011,43(9): 887-892.
84. Ozcan C, Erkocoqlu M, Civelek E, et al. The relationship between gastro-oesophageal reflux disease and asthma during childhood [J]. Allergy Immunopathol (Madr),2012, Dec 18.
85. Komatsu Y, HoppoT, Jobe BA. Et al. Proximal reflux as a cause of adult-onset asthma:the case for hypopharyngeal impedance testing to improve the sensitivity of diagnosis [J]. JAMA Surg, 2013,148(1):50-58.
86.林江涛.难治性哮喘的危险因素[J].中华哮喘杂志(电子版),2010,4(1)：1-3.
87. Kilic M, Ozturk F, Kirmemis O, et al. Impact of larygopharyngeal and gastroesophageal reflux on asthma control in children [J]. Int J Pediatr Otorhinolarygol,2013,77(3):341-345.
88.张庆宪,汤兵祥,彭义利.哮喘与肺结核的关系探讨[J].中国防痨杂志,2002,24(5)：267-269.
89. Athanazio R. Airway disease:similarities and differences between asthma, COPD and bronchiectasis. Clinics (Sao Paulo),2012,67(11):1335-1343.
90. Truong T. The overlap of bronchiectasis and immunodeficiency with asthma [J]. Immunol Allergy Clin North Am,2013,33(1):61-78.
91.林江涛,何权瀛,姚婉贞,等.北京市城区支气管哮喘患者的控制现状及对疾病认知程度的调查[J].中华结核和呼吸杂志,2007,30(7)：494-497.
92.苏楠,迟春花,董秀文,等,北京市城区门诊哮喘患者控制现状及疾病认知程度的调查分析[J].中华医学杂志,2009,89(8)：529-531.
93. Lich KH, Travers D, Psek W, et al. Emergency department visits attributable to asthma in North Carolina,2008[J]. N C Med J,2013,74(1):9-17.
94. Demoly P, Annunziata K, Gubba E, et al. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years [J]. Eur Respir Rev,2012,21(123):66-74.
95. Dalcin PT, Menegotto DM, Zanonato A, et al. Factors associated with uncontrolled asthma in Porto Alegre, Brazil [J]. Braz J Med Biol Res.2009,42(11):1097-1103.
96. Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations:insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) study [J]. Ann Allergy Asthma Immunol,2010,104(6):471-477.
97. Kirsch F, Teuner CM, Menn P, et al. Costs of illness for asthma and COPD in adults in Germany. Gesundheitswesen,2013, Apr 3.
98. Goral A, lipsitz JD, Muhsen K, et al. Depressive symptoms, risk factors and sleep in asthma: results from a national Israeli health survey [J]. Gen Hosp Psychiatry,2012,34(1):17-23.
1. 周庆涛,贺蓓.1966年以来成人哮喘患病率增高可能与对哮喘的认知和诊断有关[J].中华医学杂志,2010,90：852.
2. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in asthma prevalence, health care use, and mortality in the United States,2001-2010[J]. NCHS Data Brief,2012, (94):1-8.
3. Gershon AS, Guan J, Wang C, et al. Trends in Asthma prevalence and incidence in Ontario, Canada,1996-2005:a population study [J]. Am J Epidemiol,2010,172(6):728-736.
4. 全国儿童哮喘防治协作组.中国城区儿童哮喘患病率调查[J].中华儿科杂志,2003, 41：123-127.
5. 林江涛,殷凯生.哮喘防治新进展专题笔谈[M].北京.人民卫生出版社,2008,1-7.
6. Aiz, Dirks CG, Ulrik CS, et al. Long-term mortality among adults with asthma:A 25-year follow-up of 1075 out patients with asthma [J]. Chest,2013,12-2289.
7. 钟南山.支气管哮喘一基础与临床[M].北京：人民卫生出版社,2006,15.
8. 汤泰秦,丁勇,郑劲平,等.广东省支气管哮喘流行病学调查分析[J],中华结核和呼吸杂志,2000,23：730-733.
9. 王国斌,彭义利,杜长海,等.河南省支气管哮喘患病率调查[J],中华结核和呼吸杂志,2002,25：25-28.
10.陈萍,于润江,候显明,等.辽宁省支气管哮喘流行病学调查[J],中华结核和呼吸杂志,2002,25(10)：603-606.
11.钱娟娟,马佳韵,周敏,等.上海市宝山区支气管哮喘患病率和危险因素调查[J].内科理论与实践,2011,6：121-124.
12.丁逸鹏,姚红霞,汤小兰等.2003至2007年海南黎族支气管哮喘患病率调查[J].中华医学杂志,2012,90(44)：3112-3114.
13.刘同赏,姜涛,薛卫林等.青岛市城区成年人哮喘病因和控制情况分析[J].中国医师进修杂志,2011,34(z2)：3-5.
14.高芬,杨庆娟,张海国.2006至2007年青海省支气管哮喘患病率调查[J].中华结核和呼吸杂志,2011,34(3)：165-168.
15.陈萍.加强支气管哮喘的流行病学研究[J].中华内科杂志,2001,40(7)：433-434.
16. Pinto LA, Stein RT, Kabesch M. Impact of genetics in childhood asthma [J]. J Pediatr (Rio J),2008,84(4 Suppl):S68-75.
17. Haller G, Torgerson DQ Ober C, et al. Sequencing the IL-4 locus in African American implicates rare noncoding variants in asthma susceptibility [J]. J Allergy Clin Immunol, 2009,124(6):1204-1209.
18. Rogers AJ, Raby BA, Lasky-Su JA, et al. Assessing the reproducibility of asthma candidate gene associations, using genome-wide data [J]. Am J Respir Crit Med, 2009,179(2):1084-1090.
19. Finkelstein Y, Boumissen FG, Hutson JR, et al. Polymorphism of the ADRB2 gene and response to inhaled beta-agonists in children with asthma:a meta-analysis [J]. J Asthma, 2009,46(9):900-905.
20. Wenzel SE, Balzars, Ampleford E, et al. IL4R alpha mutations are associated with asthma exacerbations and mast cell/IgE expression [J]. Am J Respir Crit Care Med,2007,175(6): 570-576.
21. Loza MJ, Chang BL. Association between Q551R ILAR genetic variants and atopic asthma risk demonstrated by meta-analysis [J]. J Allergy Clin Immunol,2007,120(3): 578-585.
22. Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis [J]. Nat Genet,2006,38(4):441-446.
23. Lima JJ, Mohapatra S, Feng H, et al. A polymorphism in the NPPA gene associates with asthma [J]. Clin Exp Allergy,2008,38(7):1117-1123.
24. Sharma M, Batra J, Mabalirajan U, et al. A genetic variation in inositol polyphosphate 4 phosphatasea enhances susceptibility to asthma [J]. Am J Respir Crit Care Med,2008, 177(7):712-719.
25. Reijmerink NE, Kerkhof M, Koppelman GH, et al. Smoke exposure interacts with ADAM33 polymorphisms in the development of lung function and hyperresponsiveness [J]. Allergy,2009,64(6):898-904.
26. Blakey JD, Sayers I, Ring SM, et al. Positionally cloned asthma susceptibility gene polymorphisms and disease risk in the British 1958 Birth Cohort [J]. Thorax,2009,64(5): 381-387.
27. White JH, Chiano M, Wigglesworth M, et al. Identification of a novel asthma susceptibility gene on chromosome lqter and its functional evaluation [J]. Hum Mol Genet,2008,17(13):1890-1903.
28. Moffatt MF, Kabesch M, Liang L, et al. Genetic variants regulating ORMDL3 expression contribute to the risk of childhood asthma [J]. Nature,2007,448(7152):470-473.
29. Chupp GL, Lee CG, Jarjour N, et al. A chitinase-like protein in the lung and circulation of patients with severe asthma [J]. N Engl J Med,2007,357(20):2016-2027.
30. Rathche CN, Holmlkvist J, Husmoen LL, et al. Association of polymorphisms of the CH13L1 gene with asthma and atopy:a populations-based study of 6514 Danish adults [J]. PLoS One,2009,4(7):e6106.
31. Pearce N, Pekkanen J, Beasley R. How much asthma is really attributable to aotpy? [J]. Thorax,1999,54(3):268-272.
32. Ronmark EP, Ekerljung L, Lotvall J. et al. Eczema among adults:prevalence, risk factors and relation to airway diseases. Results from a large scale population survey in Sweden [J]. Br J Dermatol,2012,166(6):1301-1308.
33. Martinez FD. Viruses and atopic sensitization in the first years of life [J]. Am J Respir Crit Care Med,2000,162(3 Pt 2):S95-99.
34. Barnes KC. Evidence for common genetic elements in allergic disease [J]. J Allergy Clin Immunol,2000,106(5 Suppl):S192-S200.
35. van den Nieuwenhof L. Schermer T. Bosch Y, et al. Is physician-diagnosed allergic rhinitis a risk factor for the development of asthma? [J]. Allergy,2010,65(8):1049-1055.
36. Shaaban R, Zureik M, Soussan D, et al. Rhinitis and onset of asthma:a longitudinal population-based study [J]. Lancet,2008,372(9643):1049-1057.
37. Zhao J, He Q, Zhang G, et al. Status of asthma control in children and the effect of parent' knowledge, attitude, and practice (KAP) in China:a multicenter study [J]. Ann Allergy Asthma Immunol,2012,109(3):190-194.
38. Postma DS, Bleecker ER, Amelug PJ, et al. Genetic susceptibility to asthma-bronchial hyperresponsiveness coinherited with a major gene for atopy [J]. N Engl J Med,1995, 333(14):894-900.
39. van den Nieuwenhof L, Schermer T, Heijdra Y, et al. Are asymptomatic airway hyperresponsiveness and allergy risk factors for asthma? A longitudinal study [J]. Eur Respir J,2008,32(1):70-76.
40. Liang KL, Jiang RS, Wang RC, et al. Upper airway inflammation exacerbates bronchial hyperreactivity in mouse models of rhinosinusitis and allergic asthma. Int Forum Allergy Rhinol[J].2013, Mar 4.
41. Lipma G, Matusovsky O, Lauzon AM. Accumulating evidence for increased velocity of airway smooth muscle shortening in asthmatic airway hyperresponsiveness [J]. J Allergy (Cairo),2012, Dec 25.
42. Munoz-Lopez F. Bronchial hyperresponsiveness and asthma in the pediatric population [J]. Allergy Immunopathol (Madr),2013, Mar 12.
43. Leynaert B, Sunyer J, Garcia-Esteban R, et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma:a population-based cohort [J]. Thorax, 2012,67:625-631.
44. Gissler M, Jarvelin MR, Louhiala P, et al. Boys have more health Problems in childhood than girls; follow-up of the 1987 finish birth cohort [J]. Acta pediatr,1999,88(3): 310-314.
45. Sears MR, Burrows B, Flannery EM, et al. Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma [J]. Clin Exp Allergy,1993,23(11): 941-948.
46. Macsali F, Real FG, Omenaas ER. et al. Oral contraception, body mass index, and asthma: a cross-secional Nordic-Baltic population survey[J]. J Allergy Clin Immunol,2009,123(2): 391-397.
47. Nafti S, Taright S, El Ftouh M, et al. Prevalence of asthma in North Africa:the Asthma Insights and Reality in the Maghreb (AIRMAG) study [J]. Respir Med,2009,103 Suppl 2: S2-S11.
48.刘国梁,林江涛.肥胖与哮喘[J].中华医学杂志,2009,(89)：512.
49. Visness CM, London SJ, Daniels JL, et al. Association of childhood obesity with atopic and nonatopic asthma:results from the National Health and Nutrition Examination Survey 1999-2006 [J]. J Asthma,2010,47(7):822-829.
50. Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma:a cohort study of 118 723 males and females [J], Eur Respir J,2010,35(6):1235-242.
51. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies [J]. Am J Respir Crit Care Med,2007,175(7):661-666.
52. Farah CS, Kermode JA, Downie SR, et al. Obesity is a determinant of asthma control independent of information and lung mechanics [J]. Chest,2011,140(3):659-666.
53. Camarqo CA Jr, Sutherland ER, Bailey W, et al. Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans [J]. Curr Med Res Opin,2010,26(7):1629-1635.
54. Von Behren J, Lipsett M, Horn-Ross PL,et al. Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort [J]. Thorax,2009,64(10):889-893.
55. Leone N, Courbon D, Berr C, et al. Abdominal obesity and late-onset asthma: cross-sectional and Longitudinal Results:The 3C study[J]. Obesity (Silver Spring),2012, 20(3):628-635.
56. A Sherriff, A Maitra, A R Ness, et al. Association of duration of television viewing in early childhood with the subsequent development of asthma [J]. Thorax,2009,64(4):321-325.
57. Fenger RV, Gonzalez-Quintela A, Linneberg, et al. the relationship of serum triglycerides, serum HDL, and obesity to the risk of wheezing in 85,555 adults [J], Respir Med,2013, Mar 3.
58. Kim Y, Jo EJ, Kang SY, et al. Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma [J]. Ann Allergy Asthma Immunol,2013,110(4); 253-257.
59. Teodorescu M, Polomis DA, Teodorescu MC, et al. Association of obstructive sleep apnea risk or diagnosis with daytime asthma in adults [J]. J Asthma,2012,49(6):620-628.
60. Weqienka G, Joseph CL, Havstad S, et al. Sensitization and allergic histories differ between black and white pregnant women [J]. J Allergy Clin Immunol,2012,130(3): 657-662.
61. Weqienka G, Havstad S, Joseph CL, et al. Allergic sensitization frequency and wheezing differences in early life between black and white children [J]. Allergy Asthma Proc,2012, 33(6):493-499.
62. Winer RA, Qin X, Harrington T. et al. Asthma incidence among children and adults: findings from the Behavioral Risk Factor Surveillance system asthma call-back survey-United States,2006-2008 [J]. J Asthma,2012,49(1):16-22.
63. Zahran HS, Bailev C. Factors associated with asthma prevalence among racial and ethnic groups-United States,2009-2010 Behaviroral Risk Factor Surveillance System [J]. J Asthma,2013, Apr 11.
64. Oraka E, Iqbal S, Flanders WD, et al. Racial and Ethnic Disparities in current asthma and emergency department visits:Findings from the National Health Interview Survey, 2001-2010[J]. J Asthma,2013, Apr 2.
65. Holgate ST. The epidemic of allergy and asthma [J]. Nature,1999,402:2-4.
66. Custovic A, Simpson A. The role of inhalant allergens in allergic airways disease [J]. J Investig Allergol Clin Immunol,2012,22(6):393-401.
67. Rauh VA, Chew GR, Garfinkel RS. Deteriorated housing contributes to high cickriach allergen levels in inner-city households [J]. Environ Health Perspect,2002,110(Suppl.2): 323-327.
68. Thomas B, Heap P, Carswell F. Ultrastructural localization of the allergen Der p I in the gut of the house dust mite Dermatophagoides pteronyssinus [J]. Int Arch Allergy Appl Immunol,1991,94:365-367.
69. Witteman AM, Akkerdaas JH, van Leeuwen J, et al. Identification of a cross-reactive allergen (presumably tropomyosin) in shrimp, mite and insects [J]. Int Arch Allergy Immunol,1994,105:56-61.
70. Tsai LC, Chao PL, Hung MW, et al. Protein sequence analysis and mapping of IgE and IgG epitopes of an allergenic 98-kDa Dermatohagoides farinae paramyosin [J]. Der f 11. Allergy,2000,55(2):141-147.
71. Carayol N, Birnbaum J, Magnan A, et al. Fel d I production in the cat skin varies according to anatomical sites [J]. Allergy,2000,55(6):570-573.
72. Chapman MD, Smith AM, Vailes LD, et al. Recombinant allergens for diagnosis and therapy of allergic disease [J]. J Allergy Clin Immunol,2000,106(3):409-418.
73. Platts-Mills T, Vauhan J, Squillace S, et al. Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen:a population-based cross-sectional study [J]. Lancet,2001,357(9258):752-756.
74. Kailasnath VP, Raj S, Sublett JL. Mouse allergen skin sensitization in asthmatic children of suburban, rural, and inner-city populations [J]. Allergy Asthma Proc,2013,34(2): 176-178.
75. Arruda LK, Chapman MD. The role of cockroach allergens in asthma [J]. Curr Opin Pulm Med,2001,7(1):14-19.
76. National Institute of Health (NIH). National Heart, Lung and Blood Insitiute (NHLBI) /World Health Organization (WHO). Global strategy for asthma management and prevention. Global Initiative for asthma. NIH Publication,2011,1-124.
77. James KM, Peebles RS Jr, Hartert TV. Response to infections in patients with asthma and atopioc disease:An epiphenomenon or reflection of host susceptibility? [J]. J Allergy Clin Immunol,2012,30(2):343-351.
78. Kim EY, Battaile JY, Patel AC, et al. Persistent activation of an innate immune response translates respiratory viral infection into chronic lung disease [J]. Nat Med,2008,14: 633-640.
79. Strachan D P. Hay fever, hygiene and household size [J]. BMJ,1989,299(6710): 1259-1260.
80. Lin AH, Leung DY. Renaissance of the hygiene hypothesis [J]. J Allergy Clin Immunol, 2006,117(5):1063-1066.
81.王红玉,陈育智,马渝,等.中国儿童哮喘患病率的地区差异与生活方式的不同有关[J].中华儿科杂志,2006,44(1)：41-45.
82. Schaub B, Lauener R, von Mutius E. The many faces of the hygiene hypothesis [J]. J Allergy Clin Immunol,2006,117(5):969-977.
83. Taube C, Muller A. The role of Helicobacter pylori infection in the development of allergic asthma [J]. Expert Rev Respir Med,2012,6(4):441-449.
84. Alm B, MD, Erdes L, Mollborg P. et al. Neonatal antibiotic treatment is a risk factor for early wheezing [J]. Pediatrics,2008,121(4):697-702.
85. Stanley J Szefler, Donald Y. M. Leung. Severe Asthma:Pathogenesis and Clinical Management [M]. New York:Marcel Dekker, Inc,2001,389-418.
86. Michelle K. McHugh, Elaine Symanski, Lisa A. Pompeii, et al. Prevalence of asthma by industry and occupation in the U.S. working population [J]. Am. J. Ind, Med.2010,53: 463-475.
87. Centers for Disease Control and Prevention (CDC). Work-related asthma--38 states and District of Columbia,2006-2009[J]. MMWR Morb Mortal Wkly Rep,2012,61:375-378.
88. Eng A, T Mannetje A, Douwes J, et al. The New Zealand workforce survey Ⅱ:occupational risk factors for asthma [J]. Ann Occup Hyg,2010,54(2):154-164.
89.王雷,闫永健.职业性哮喘70例的职业特征[J].职业与健康,2008,24(9)：831-832.
90. Tagiyeva N, Devereux G, Semple S, et al. Parental occupation is a risk factor for childhood wheeze and asthma [J]. Eur Respir J,2010,35(5):987-993.
91. Frampton MW, Utell MJ, Zareba W, et alEffects of exposure to ultrafine carbon particles in healthy subjects and subjects with asthma[J]. Res Rep Health Eff Inst,2004, 12(126):1-47.
92. Penard-Morand C, Raherison C, Charpin D, et al. Long-term exposure to close-proximity air pollution and asthma and allergies in urban children [J]. Eur Respir J,2010,36(1): 33-40.
93. Baumann LM, Robinson CL, Combe JM, et al. Effects of distance from a heavily transited avenue on asthma and atopy in a periurban shantytown in Lima, Peru [J]. J Allergy Clin Immunol,2011,127(4):875-882.
94. Bernstein DI. Traffic-related pollutants and wheezing in children [J]. J Asthma,2012, 49(1):5-7.
95. Yeatts K, Svendsen E, Creason J, et al. Coarse particulate matter(PM 2.5-10) affects heart rate variability, blood lipids, and circulating eosinophils in adults with asthma[J]. Environ Health Perspect,2007,115(5):719-714.
96. Auten RL, Mason SN, Potts-Kant EN, et al. Early life Ozone exposure induces adult murine airway hyperresponsiveness through effects on airway permeability [J]. J Appl Physiol,2103,Apr 4.
97. Tong H, Rappold AG, Diaz-Sanchez D. Omega-3 fatty acid supplementation appears to attenuate particulate air pollution-induced cardiac effects and lipid changes in healthy middle-aged adults [J].Environ Health Perspect,2012,120(7):952-957.
98. Shea KM, Truckner RT, Weber RW, et al. Climate change and allergic disease [J]. J Allergy Clin Immunol,2008,122(3):443-453.
99. Pekkanen J, Hwarinen A, Haverinen-Shaughnessy U, et al. Moisture damage and childhood asthma:a population-based incident case-control study [J]. Eur Respir J,2007, 29(3):509-515.
100. Agrawal S. Effect of indoor air pollution from biomass and solid fuel combustion on prevalence of self-reported asthma among adult men and women in India:findings from a nationwide large-scale cross-sectional survey [J]. J Asthma,2012,49(4):355-365.
101. Annesi-Maesano I, Hulin M, Lavaud F, et al. Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study [J]. Thorax, 2012,67(8):682-688.
102. LU KD, Breysse PN, Diette GB, et al. Being overweight increases susceptibility to indoor pollutants among urban children with asthma [J]. J Allergy Clin Immunol,2013, S0091-6749.
103. Nakamura K, Nagata C, Fujii K, et al. Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women [J]. Ann Allergy Asthma Immonol,2009,102(4): 288-293.
104. Siroux V, Pin I, Oryszczyn MP, et al. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of asthma [J]. Eur Respir J,2000,15(3):470-477.
105. Wahlgren DR. Involuntary smoking and asthma [J]. Curr Opin Plum Med,2000,6:31-36.
106. Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze:systematic review and meta-analysis [J]. Pediatric,2012, 129(4):735-744.
107. Xepapadaki P, Manios Y, Liarigkovinos T, et al. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children [J]. Pediatr Allergy Immunol,2009,20(5):423-429.
108. Chalmers GW, Macleod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma [J]. Thorax,2002,57(3):226-230.
109. Tan NC, Nqoh SH, Teo SS, et al. Impact of cigarette smoking on symptoms and quality of life of adults with asthma managed in public primary care clinics in Singapore:a questionnaire study [J]. Prim Care Respir J,2012,21(1):90-93.
110. Zaknun D, Schroecksnadel S, Kurz K, et al. Potential role of antioxidant food supplements, preservatives and colorants in the pathogenesis of allergy and asthma [J]. Int Arch Allergy Immunol,2012,157(2):113-124.
111. Scholtens S, Wijga AH, Brunekreef B, et al. Breast feeding, parental allergy and asthma in children followed for 8 years. The PLAMA birth cohort study [J]. Thorax,2009,64(7): 604-609.
112. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy:Systematic review and meta-analysis [J]. J Allergy Clin Immunol, 2011,127(3):724-733.
113. Torres-Borrego J, Moreno-Solis G, Molina-Teran AB. Diet for the prevention of asthma and allergies in early childhood:much do about something? [J]. Allergol Immunopathol (Madr),2012,40(4):244-252.
114. Wood L G, Gibson PG. Dietary factors lead to innate immune activation in asthma [J]. Pharmacol Ther,2009,123(1):37-53.
115. Maslova E, Strom M, Olsen SF,et al. Consumption of artificially-sweetened soft drinks in pregnancy and risk of child asthma and allergic rhinitis [J]. Epub, PloS One,2013,8(2): e57162.
116. Hsu NY, Wu PC, Bornehag CG, et al. Feeding bottles usage and the prevalence of childhood allergy and asthma [J]. Clin Dev Immunol,2012:158248.
117. Maslova E, Halldorsson TI, Strem M, et al. Low-fat yoghurt intake in pregnancy assoiciated with increased child asthma and allergic rhinitis risk:a prospective cohort study [J].J Nutr,2012,6:1.
118. Maslova E, Strom M, Olsen E, et al. Fish intake duringpregnancy and the risk of child asthma and allergic rhinitis longitudinal evidence from the Danish National Birth Cohort [J]. Br J Nutr,2013,8:1-13.
119. Gale CR, Robinson SM, Harvey NC, el al. Maternal vitamin D status during pregnancy and child outcomes [J]. Eur J Clin Nutr,2008,62:68-77.
120. Bener A, Ehlayel MS, Tulic MK, et al. Vitamin D deficiency as a strong predictor of asthma in children [J]. Int Arch Allergy Immunol,2012,157(2):168-175.
121. Erkkola M, Nwaru BI, Kaila M, et al. Risk of asthma and allergic outcomes in the offspring in relation to maternal food consumption during pregnancy:a Finish birth cohort study [J]. Pediatr Allergy Immunol,2012,23(2):186-194.
122. Brehm JM, Celedon JC, Soto-Quiros ME, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica [J]. Am J Respir Crit Care Med,2009,179(9): 765-771.
123. Crump C, Winkleby MA, Sundquist J, et al. Risk of asthma in young adults who were born preterm:a Swedish national cohort study[J]. Pediatrics,2011,127(4):e913-920.
124. Steffensen FH, Sorensen HT, Gillman MW, et al. Low birth weight and preterm delivery as risk factors for asthma and atopic dermatitis in young adult males[J]. Epidemiology,2000,11(2):185-188.
125. Tedner SG, Ortqvist AK, Almqvist C. et al. Fetal growth and risk of childhood asthma and allergic disease [J]. Clin Exp Allergy,2012,42(10):1430-1437.
126. Ekerljung L, Sundblad BM, Ronmark E, et al. Incidence and prevalence of adult asthma is associated with low socio-economic status [J]. Clin Respir J,2010,4(3):147-156.
127. Goldberg S, Israeli E, Schwartz S, et al. Asthma prevalence, family Size, and birth order [J]. Chest,2007,131(6):1747-1752.
128. Eijkemans M, Mommers M, Draaisma, et al. Physical activity and asthma:a systematic review and mata-analysis [J]. Epub PLouS One,2012,7(12):e50775.
129.张晓岩,林江涛.支气管哮喘发病的危险因素[J].中华哮喘杂志(电子版),2007,1(1)：1-4.
130. Genuneit J, Strachan DP, Bchele G, et al. The combined effects of family size and farm exposure on childhood hay fever and atopy [J]. Pediatr Allergy Immunol,2013, Apr 3.
131. Suqlia SF, Duarte CS, Sandel MT, et al. Social and environmental stressors in the home and childhood asthma [J]. J Epidemiol Community Health,2010,64(7):636-642.
132. Chun TH, Weitzen SH, Fritz GK. The asthma/mental health nexus in a population-based sample of the United States [J]. Chest,2008,134(6):1176-1182.
133. Milam J, McConnell R, Yao L, et al. Parental stress and childhood wheeze in a prospective cohort study [J]. J Asthma,2008,45(4):319-323.
134. Kozyrskyi AL, Mai XM, Mc Grath P, et al. Continued exposure to maternal distress in early life associated with an increased risk of childhood asthma [J]. Am J Respir Crit Care Med,2008,15(177):142-147.
135. Sandberg S, Jarvenpaa S, Penttinen A, et al. Asthma exacerbations in children immediately following stressful life events:a Cox's hierarchical regression [J]. Thorax, 2004,59(12):1046-1051.
136.钟南山.我国支气管哮喘防治研究重点及努力方向[J].中华结核和呼吸杂志,2005,28(12)：809-811.