Characterization of Asthma Trajectories from Infancy to Young Adulthood

Abstract

Development of asthma is complicated by the multidimensional nature of the disease. To identify and characterize trajectories of asthma from infancy to young adulthood, and their associations with lung function and inflammatory and respiratory markers in adolescence and young adulthood. A latent class analysis was performed in a population-based cohort (N= 4089). Parental and self-reported symptoms of asthma were used to investigate asthma development. We characterized background factors, allergic comorbidity, and IgE sensitization and investigated associations with asthma markers. A 4-class solution of asthma trajectories was identified: never/infrequent (n= 3291 [80.4%]), early-onset transient (n= 307 [7.5%]), adolescent-onset (n= 261 [6.4%]), and persistent asthma (n= 230 [5.6%]). Uncontrolled asthma was equally prevalent in the adolescent-onset and persistent asthma trajectory groups, at both age 16 (41.7% vs 42.4%; P= .90) and 24 years (53.7% vs 52.4%; P= .81). The persistent asthma trajectory group had a higher proportion of eosinophil counts greater than or equal to 0.3 (109 cells/L) at age 24 years compared with the adolescent-onset trajectory group (31.0% vs 18.5%; P < .01). The adolescent-onset and persistent asthma trajectory groups had equal burdens of asthma control in adolescence and young adulthood. However, the persistent asthma trajectory group showed more signs of type 2 inflammation than the adolescent-onset trajectory group. This unbiased approach highlights the need of identifying patients with adolescent asthma to optimize care, because they suffer the same lack of asthma control as those with persistent asthma.