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Preschool-age wheezing phenotypes and asthma persistence in adolescents

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Background:

Predicting long-term outcomes in individuals with childhood wheezing is of major clinical relevance.

Objective:

To identify and characterize childhood wheezing phenotypes related to asthma persistence in adolescence with a multidimensional statistical model, independent of predefined hypotheses.

Methods:

This prospective cohort study included 308 children, ages < 7 years, with recurrent wheezing. We systematically evaluated asthma prevalence in children at 3, 8, and 13 years of follow-ups. Risk factors associated with asthma persistence in adolescence were analyzed with multivariable logistic regression. Early childhood wheezing phenotypes were identified with k-means cluster analysis of variables selected with the logistic regression analysis, which were based on questionnaires and skin-prick tests. These phenotypes were compared for predicting asthma prevalence, use of control treatments, and lung function in childhood and adolescence.

Results:

Asthma prevalence was 58.3% (n = 249) and 53.5% (n = 170) at the 8- and 13-year follow-ups, respectively. Preschool-age diagnoses of atopy (odds ratio 11.8 [95% confidence interval, 4.0‐34.6]) and rhinitis (odds ratio 10.4 [95% confidence interval, 3.7‐29.1]) were independent risk factors for asthma persistence in adolescence. We identified three early childhood wheezing phenotypes: transient, persistent atopic, and persistent nonatopic. The latter two were characterized by rhinitis during preschool age. These phenotypes could predict the following outcomes: asthma symptom persistence, use of control treatments, and lung function during childhood and adolescence (p < 0.03).

Conclusion:

Asthma persistence through adolescence reflected different wheezing phenotypes based on preschool-age comorbidities, particularly rhinitis, with or without atopy. Our results supported that wheezing phenotypes, identified at early ages from simple measurements, could predict asthma and lung function outcomes.
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Keywords: Asthma; atopy; children; cohort; outcome; phenotype; prognosis; rhinitis; risk factors; wheeze

Document Type: Research Article

Affiliations: Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal

Publication date: 01 May 2016

This article was made available online on 30 March 2016 as a Fast Track article with title: "Preschool-age wheezing phenotypes and asthma persistence in adolescents".

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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