title: The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts.
abstract: U-BIOPRED aims to characterise paediatric and adult severe asthma using conventional and innovative systems biology approaches. A total of 99 school-age children with severe asthma and 81 preschoolers with severe wheeze were compared with 49 school-age children with mild/moderate asthma and 53 preschoolers with mild/moderate wheeze in a cross-sectional study. Despite high-dose treatment, the severe cohorts had more severe exacerbations compared with the mild/moderate ones (annual medians: school-aged 3.0 versus 1.1, preschool 3.9 versus 1.8; p<0.001). Exhaled tobacco exposure was common in the severe wheeze cohort. Almost all participants in each cohort were atopic and had a normal body mass index. Asthma-related quality of life, as assessed by the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), was worse in the severe cohorts (mean±se school-age PAQLQ: 4.77±0.15 versus 5.80±0.19; preschool PACQLQ: 4.27±0.18 versus 6.04±0.18; both p≤0.001); however, mild/moderate cohorts also had significant morbidity. Impaired quality of life was associated with poor control and airway obstruction. Otherwise, the severe and mild/moderate cohorts were clinically very similar. Children with severe preschool wheeze or severe asthma are usually atopic and have impaired quality of life that is associated with poor control and airflow limitation: a very different phenotype from adult severe asthma. In-depth phenotyping of these children, integrating clinical data with high-dimensional biomarkers, may help to improve and tailor their clinical management.
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Fleming
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Murray
authors.affiliation: Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK.
authors.forename: Aruna T
authors.initials: AT
authors.lastname: Bansal
authors.affiliation: Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Bisgaard
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK Dept of Paediatrics, Imperial College London, London, UK Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
authors.affiliation: University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Frey
authors.affiliation: Dept of Women's and Children's Health and Center for Allergy Research, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Hedlin
authors.affiliation: University Children's Hospital Zurich, Zurich, Switzerland University Children's Hospital Bern, Bern, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Singer
authors.affiliation: Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wim M
authors.initials: WM
authors.lastname: van Aalderen
authors.affiliation: Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Nadja H
authors.initials: NH
authors.lastname: Vissing
authors.affiliation: NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
authors.forename: Zaraquiza
authors.initials: Z
authors.lastname: Zolkipli
authors.affiliation: NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Selby
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK Airways Clinic, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fowler
authors.affiliation: Respiratory Research Unit, University of Nottingham, Nottingham, UK.
authors.forename: Dominick
authors.initials: D
authors.lastname: Shaw
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK NIHR Biomedical Research Unit, Royal Brompton NHS Trust, London, UK.
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
authors.affiliation: Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, UK.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Sousa
authors.affiliation: BioSci Consulting, Maasmechelen, Belgium.
authors.forename: Scott
authors.initials: S
authors.lastname: Wagers
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden Areteva, Nottingham, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Corfield
authors.affiliation: Data Science Institute, South Kensington Campus, Imperial College London, London, UK.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pandis
authors.affiliation: Janssen R&D Ltd, High Wycombe, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rowe
authors.affiliation: CROMSOURCE, Verona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Formaggio
authors.affiliation: Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Sterk
authors.affiliation: NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences and Human Development and Health, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK g.c.roberts@soton.ac.uk.
authors.forename: Graham
authors.initials: G
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate; D008297:Male; D010372:Pediatrics; D011446:Prospective Studies; D011788:Quality of Life; D012135:Respiratory Sounds / Q000175:diagnosis; D012720:Severity of Illness Index; D013147:Spirometry; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D014028:Tobacco Smoke Pollution