TY - JOUR
T1 - Heterogeneity of Mild to Moderate Persistent Asthma in Children
T2 - Confirmation by Latent Class Analysis and Association with 1-Year Outcomes
AU - Fitzpatrick, Anne M.
AU - Bacharier, Leonard B.
AU - Jackson, Daniel J.
AU - Szefler, Stanley J.
AU - Beigelman, Avraham
AU - Cabana, Michael
AU - Covar, Ronina
AU - Guilbert, Theresa
AU - Holguin, Fernando
AU - Lemanske, Robert F.
AU - Martinez, Fernando D.
AU - Morgan, Wayne
AU - Phipatanakul, Wanda
AU - Pongracic, Jacqueline A.
AU - Raissy, Hengameh H.
AU - Zeiger, Robert S.
AU - Mauger, David T.
N1 - Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology
PY - 2020/9
Y1 - 2020/9
N2 - Background: Compared with adults, phenotypic characterization of children with asthma is still limited and it remains difficult to predict which children with asthma are at highest risk for poor outcomes. Objective: To identify latent classes in a large population of treatment-adherent children with mild to moderate asthma enrolled in clinical trials and determine whether latent class assignment predicts future lung function abnormalities and exacerbation rate. Methods: Latent class analysis was performed on 2593 children with mild to moderate asthma aged 5 18 years, with 19 variables encompassing demographic characteristics, medical history, symptoms, lung function, allergic sensitization, and type 2 inflammation. Outcomes included lung function and the annualized exacerbation rate at 12 months of follow-up. Results: Five latent classes were identified with differing demographic features, asthma control, sensitization, type 2 inflammatory markers, and lung function. Exacerbation rates were 1.30 ± 0.12 for class 1 (multiple sensitization with partially reversible airflow limitation), 0.90 ± 0.05 for class 2 (multiple sensitization with reversible airflow limitation), 0.87 ± 0.08 for class 3 (lesser sensitization with reversible airflow limitation), 0.87 ± 0.05 for class 4 (multiple sensitization with normal lung function), and 0.71 ± 0.06 for class 5 (lesser sensitization with normal lung function). Lung function abnormalities persisted in class 1 at 12 months. Conclusions: Children with mild to moderate asthma are a heterogeneous group. Allergic sensitization and lung function may be particularly useful in identifying children at the greatest risk for future exacerbation. Additional studies are needed to determine whether latent classes correspond to meaningful phenotypes for the purpose of personalized treatment.
AB - Background: Compared with adults, phenotypic characterization of children with asthma is still limited and it remains difficult to predict which children with asthma are at highest risk for poor outcomes. Objective: To identify latent classes in a large population of treatment-adherent children with mild to moderate asthma enrolled in clinical trials and determine whether latent class assignment predicts future lung function abnormalities and exacerbation rate. Methods: Latent class analysis was performed on 2593 children with mild to moderate asthma aged 5 18 years, with 19 variables encompassing demographic characteristics, medical history, symptoms, lung function, allergic sensitization, and type 2 inflammation. Outcomes included lung function and the annualized exacerbation rate at 12 months of follow-up. Results: Five latent classes were identified with differing demographic features, asthma control, sensitization, type 2 inflammatory markers, and lung function. Exacerbation rates were 1.30 ± 0.12 for class 1 (multiple sensitization with partially reversible airflow limitation), 0.90 ± 0.05 for class 2 (multiple sensitization with reversible airflow limitation), 0.87 ± 0.08 for class 3 (lesser sensitization with reversible airflow limitation), 0.87 ± 0.05 for class 4 (multiple sensitization with normal lung function), and 0.71 ± 0.06 for class 5 (lesser sensitization with normal lung function). Lung function abnormalities persisted in class 1 at 12 months. Conclusions: Children with mild to moderate asthma are a heterogeneous group. Allergic sensitization and lung function may be particularly useful in identifying children at the greatest risk for future exacerbation. Additional studies are needed to determine whether latent classes correspond to meaningful phenotypes for the purpose of personalized treatment.
KW - Aeroallergen sensitization
KW - Asthma control
KW - Asthma exacerbation
KW - Asthma in children
KW - Asthma outcomes
KW - Latent class analysis
KW - Lung function
KW - Phenotype
KW - Type 2 inflammation
UR - http://www.scopus.com/inward/record.url?scp=85082476655&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2020.02.032
DO - 10.1016/j.jaip.2020.02.032
M3 - Article
C2 - 32156610
AN - SCOPUS:85082476655
SN - 2213-2198
VL - 8
SP - 2617-2627.e4
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 8
ER -