Phenotypes of persistent asthma in adolescents revealed different patterns in longitudinal asthma-related outcomes

Abstract

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate, longitudinally, their asthma-related outcomes. A secondary analysis was performed on the prospective, observational and multicenter INSPIRERS studies, and 162 adolescents (13–17 years; 51% male) were analysed. Latent class analysis was applied to 10 variables easily collected in baseline medical visits, both at primary and secondary care, comprehending demographic, environmental, and clinical domains. Longitudinal changes in clinical variables were assessed at a 4-month telephone visit (n=128). A three-class model was selected as the best solution. Adolescents in class 1 (n=87; 68%) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits/month and exacerbations/month, both at baseline and follow-up. Class 2 (n=32; 25%) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms (both measured by Control of Allergic Rhinitis and Asthma Test, CARAT) at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p<0.001). Class 3 (n=43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in the number of exacerbations/month (p=0.015). We identified three distinct phenotypes of persistent asthma in adolescents that differed in longitudinal patterns of asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.