Abstract
BackgroundTreatment 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.MethodsWe 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.ResultsFour 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.ConclusionsLate-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.
Highlights
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
Persistent troublesome wheeze is known to be associated with atopy, bronchial hyperresonsiveness (BHR), and decreased pulmonary function compared with controlled asthma [6, 14], these studies described phenotypes of preschool wheezing based on temporal patterns of symptoms combined with symptom control
No study has shown how environmental factors combined with genetic factors reflected in parental history of allergic diseases and demographic factors are associated with the heterogeneity of asthma, which would be helpful to investigate the origin of asthma
Summary
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. The complex interactions between environmental and genetic factors affect the development and progression of asthma, studies on asthma phenotypes considering environmental factors are limited. Epidemiologic studies have considered instability of asthma phenotypes over time [3, 4, 7] and identified associated risk factors for each asthma phenotype [9]. Few studies artificially classified asthma phenotypes according to onset age and/or persistence of wheezing, despite diverse factors affecting the development and progression of asthma [9, 11]. Another study showed that sex is a risk factor for different asthma phenotypes [15] These studies have limitations in identification of the underlying pathology according to phenotypes. No study has shown how environmental factors combined with genetic factors reflected in parental history of allergic diseases and demographic factors are associated with the heterogeneity of asthma, which would be helpful to investigate the origin of asthma
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