title: Persistent asthma phenotype related with late-onset, high atopy, and low socioeconomic status in school-aged Korean children.
abstract: BACKGROUND
  Treatment guidelines for asthma have been established based on asthma severity; there are limitations in the identification of underlying pathophysiology and prediction of prognosis in heterogeneous phenotypes of asthma. Although the complex interactions between environmental and genetic factors affect the development and progression of asthma, studies on asthma phenotypes considering environmental factors are limited. This study aimed to identify asthma phenotypes using latent class analysis including environmental factors in school-age children.
  
  
  METHODS
  We included 235 children (6-8 years) with parent-reported, physician-diagnosed asthma from the Children's HEalth and Environmental Research (CHEER) study, which is a 4-year prospective follow-up study with 2-year intervals. At every survey, pulmonary function tests, methacholine challenge tests and blood tests with questionnaire were conducted.
  
  
  RESULTS
  Four asthma phenotypes were identified. Cluster 1 (22% of children) was characterized by high prevalence of atopy and mild symptoms; subjects in cluster 2 (17%) consisted of less atopy and normal lung function, but intermittent troublesome; cluster 3 (29%) experienced late-onset atopic troublesome asthma with decreased lung function in combination with low socioeconomic status; and cluster 4 was associated with early-onset and less-atopic infrequent asthma.
  
  
  CONCLUSIONS
  Late-onset, high atopy, and low socioeconomic status are associated with troublesome persistent asthma phenotype in school-age children. Environmental factors might be implicated in the clinical heterogeneity of asthma. Asthma phenotypes considering diverse factors might be more helpful in the identification of asthma pathogenesis and its prevention.
authors.affiliation: Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
authors.affiliation: Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Si Hyeon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Ji-Won
authors.initials: JW
authors.lastname: Kwon
authors.affiliation: Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Jisun
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Hyun-Ju
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors.forename: Song-I
authors.initials: SI
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, CHA University School of Medicine, Seongnam, South Korea.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Hyung Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Dankook University College of Medicine, Cheonan, South Korea.
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
authors.forename: Hyo Bin
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea.
authors.forename: Ho-Jang
authors.initials: HJ
authors.lastname: Kwon
authors.affiliation: Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea. sjhong@amc.seoul.kr.
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D017668:Age of Onset; D001249:Asthma / Q000145:classification* / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications*; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D010641:Phenotype; D011446:Prospective Studies; D056910:Republic of Korea; D012129:Respiratory Function Tests; D012574:Schools; D012923:Social Class
chemical_list: D015415:Biomarkers; D007073:Immunoglobulin E
keywords: Asthma; Atopy; Children; Phenotype; Socioeconomic status