Joint modeling of parentally reported and physician-confirmed wheeze identifies children with persistent troublesome wheezing - 02/09/13
, Angela Simpson, MD, PhD a, ∗, Aida Semic-Jusufagic, MD, PhD a, Clare S. Murray, MD a, Iain Buchan, MD, PhD b, Andrew Pickles, PhD c, Adnan Custovic, MD, PhD aAbstract |
Background |
Previous studies have suggested the presence of different childhood wheeze phenotypes through statistical modeling based on parentally reported wheezing.
Objective |
We sought to investigate whether joint modeling of observations from both medical records and parental reports helps to more accurately define wheezing disorders during childhood and whether incorporating information from medical records better characterizes severity.
Methods |
In a population-based birth cohort (n = 1184), we analyzed data from 2 sources (parentally reported current wheeze at 4 follow-ups and physician-confirmed wheeze from medical records in each year from birth to age 8 years) to determine classes of children who differ in wheeze trajectories. We tested the validity of these classes by examining their relationships with objective outcomes (lung function, airway hyperreactivity, and atopy), asthma medication, and severe exacerbations.
Results |
Longitudinal latent class modeling identified a 5-class model that best described the data. We assigned classes as follows: no wheezing (53.3%), transient early wheeze (13.7%), late-onset wheeze (16.7%), persistent controlled wheeze (13.1%), and persistent troublesome wheeze (PTW; 3.2%). Longitudinal trajectories of atopy and lung function differed significantly between classes. Patients in the PTW class had diminished lung function and more hyperreactive airways compared with all other classes. We observed striking differences in exacerbations, hospitalizations, and unscheduled visits, all of which were markedly higher in patients in the PTW class compared with those in the other classes. For example, the risk of exacerbation was much higher in patients in the PTW class compared with patients with persistent controlled wheeze (odds ratio [OR], 3.58; 95% CI, 1.27-10.09), late-onset wheeze (OR, 15.92; 95% CI, 5.61-45.15), and transient early wheeze (OR, 12.24; 95% CI, 4.28-35.03).
Conclusion |
We identified a novel group of children with persistent troublesome wheezing, who have markedly different outcomes compared with persistent wheezers with controlled disease.
Le texte complet de cet article est disponible en PDF.Key words : Childhood asthma, asthma endotypes, wheeze phenotypes, longitudinal analysis
Abbreviations used : AHR, BIC, FVC, GP, ICS, LOW, MWD, NW, OR, PCW, PTW, sIgE, SPT, sRaw, STRA, TEW
Plan
| The Manchester Asthma and Allergy Study is supported by the JP Moulton Charitable Foundation, MRC Grants G0601361 and MR/K002449/1, the National Institute for Health Research Clinical Research Facility at University Hospital of South Manchester NHS Foundation Trust, and Asthma UK grant no. 04/014. This report is independent research supported by the National Institute for Health Research Clinical Research Facility at University Hospital of South Manchester NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. |
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| Disclosure of potential conflict of interest: A. Simpson has received grants from the Medical Research Council, Asthma UK, and the JP Moulton Charitable Foundation. C. S. Murray has received payment for lectures from GlaxoSmithKline. A. Pickles has received a Research Council Grant from the University of Manchester, has received grants from the Research Council and National Institute for Health, has received royalties for an autism screening questionnaire and statistical textbooks, has received payment for development of educational presentations for university lectures, and has received travel accommodations paid for under grant funding. A. Custovic has received grants from the Moulton Charitable Foundation and has received payment for lectures from GlaxoSmithKline, Thermo Fisher Scientific, Airsonet, Novartis, Merck Sharp & Dohme, and ALK-Abelló. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 132 - N° 3
P. 575 - septembre 2013 Retour au numéro
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