Change in the manifestations of asthma and asthma-related traits in childhood: a latent transition analysis.
It is known that asthma is a heterogeneous entity whose manifestations vary with age. Our objective was to examine changes in the manifestation of asthma and asthma-related traits in childhood by defining empirically derived childhood asthma phenotypes and examining their transitions over time.To define the phenotypes we used data on respiratory symptoms, healthcare utilisation, medications, spirometry, airway hyperresponsiveness (AHR), exhaled nitric oxide concentration and atopy from a birth cohort recruited on the basis of having a first-degree relative with asthma. Data were acquired at ages 1.5-11.5 years and analysed using latent transition analysis.In a study population of 370 participants, we classified subjects into four phenotypes: 1) nonatopic, few symptoms (prevalence range from 1.5 to 5 years: 52-60%), 2) atopic, few symptoms (3-21%), 3) nonatopic, asthma and rhinitis symptoms (13-35%), and 4) atopic, asthma and rhinitis symptoms (2-14%) in early childhood; and 1) nonatopic, no respiratory disease (prevalence range from 8 to 11.5 years: 41-46%), 2) atopic, no respiratory disease (23-33%), 3) nonatopic, asthma symptoms, no AHR or airway inflammation (8-12%) and 4) atopic asthma (19%) in mid-childhood. Transitioning between phenotypes was common in early childhood, but less common in later childhood.This analysis represents the first attempt to incorporate longitudinal patterns of several manifestations of asthma into a single model to simultaneously define phenotypes and examine their transitions over time. It provides quantitative support for the view that asthma is a heterogeneous entity, and that some children with wheeze and other respiratory symptoms in early life progress to asthma in mid-childhood, while others become asymptomatic.
Sydney School of Public Health, University of Sydney, Sydney, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Woolcock Institute of Medical Research, Sydney, Australia Ingham Institute of Applied Medical Research, Sydney, Australia frances.garden@sydney.edu.au.
Frances L
FL
Garden
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Judy M
JM
Simpson
Central Clinical School, University of Sydney, Sydney, Australia.
Craig M
CM
Mellis
South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Woolcock Institute of Medical Research, Sydney, Australia.
Guy B
GB
Marks
D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D001944:Breath Tests; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000503:physiopathology; D007223:Infant; D016015:Logistic Models; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D010641:Phenotype; D012130:Respiratory Hypersensitivity / Q000150:complications / Q000503:physiopathology; D065631:Rhinitis, Allergic / Q000150:complications / Q000503:physiopathology; D012912:Sneezing; D013147:Spirometry
D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D009569:Nitric Oxide