Wheeze phenotypes in young children have different courses during the preschool period.
BACKGROUND
Rules for predicting the course of asthma in wheezy infants have low specificity.


OBJECTIVE
To determine if the novel phenotypes-mild early viral wheeze (EVW), atopic multiple-trigger wheeze (MTW), and nonatopic uncontrolled wheeze (NAUW)-have different courses during the preschool period.


METHODS
Part of the prospectively followed Trousseau Asthma Program cohort was phenotyped using cluster analysis with 12 parameters (sex, asthma severity and control with inhaled corticosteroid [ICS], parental asthma, allergic rhinitis, eczema, food allergy, EVW or MTW, and allergen exposure trigger). Wheezing trajectories were assessed by crossing the original phenotypes with the phenotypes obtained at 5 years.


RESULTS
Four clusters were identified at 5 years of age: asymptomatic children (n = 47) with no wheezing (98%), children with mild EVW (n = 40, 87% with EVW, 50% with EVW controlled with low-dose ICS), those with atopic MTW (n = 30, 100% with MTW, only 17% with MTW controlled with low-dose ICS, more significant for pollen asthmatic trigger), and those with atopic severe UW (n = 33, 63% with UW uncontrolled despite high doses of ICS, more significant for allergic rhinitis and dust as asthmatic trigger). Those with mild EVW became asymptomatic or remained with mild EVW. Those with atopic MTW remained with atopic MTW and those with NAUW developed severe UW in most cases.


CONCLUSIONS
These results show that remission is most frequently observed in mild EVW and that no remission is observed in atopic MTW.
Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, Université Pierre et Marie Curie, Paris, France. Electronic address: jocelyne.just@trs.aphp.fr.
Jocelyne
J
Just
Philippe
P
Saint-Pierre
Rahele
R
Gouvis-Echraghi
Bernard
B
Boutin
Virginie
V
Panayotopoulos
Nabila
N
Chebahi
Aldjia
A
Ousidhoum-Zidi
Cam-Anh
CA
Khau
D001249:Asthma / Q000175:diagnosis*; D002675:Child, Preschool; D004485:Eczema / Q000175:diagnosis; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010641:Phenotype; D011379:Prognosis; D012135:Respiratory Sounds / Q000175:diagnosis*; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis*; D012720:Severity of Illness Index