Anne M. Fitzpatrick, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Ga
Leonard B. Bacharier, Department of Pediatrics, Washington University and St Louis Children’s Hospital, St Louis, Mo
Daniel J. Jackson, Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Stanley J. Szefler, Children’s Hospital Colorado and Department of Pediatrics, University of Colorado, Aurora, Colorado
Avraham Beigelman, Department of Pediatrics, Washington University and St Louis Children’s Hospital, St Louis, Mo
Michael Cabana, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York, NY
Ronina Covar, Department of Pediatrics, National Jewish Health, Denver, Colorado
Theresa Guilbert, Department of Pediatrics, University of Cincinnati and Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio
Fernando Holguin, Department of Medicine, University of Colorado, Denver, Colorado
Robert F. Lemanske, Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Fernando D. Martinez, Department of Pediatrics, The University of Arizona, Tucson, Arizona
Wayne Morgan, Department of Pediatrics, The University of Arizona, Tucson, Arizona
Wanda Phipatanakul, Division of Allergy and Immunology, Boston Children's Hospital and Harvard Medical School Department of Pediatrics, Boston, Massachusetts
Jacqueline A. Pongracic, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illnois
Hengameh H. Raissy, Department of Pediatrics, University of New Mexico, Albuquerque, NM
Robert S. Zeiger, Kaiser Permanente, Southern California Region and Department of Pediatrics, University of California San Diego, San Diego, California
David T. Mauger, Department of Public Health Sciences, Penn State University, Hershey, PA

Document Type

Article

Publication Date

9-1-2020

Abstract

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.

Publication Title

J Allergy Clin Immunol Pract

ISSN

2213-2201

Volume

8

Issue

8

First Page

2617

Last Page

2627

DOI

10.1016/j.jaip.2020.02.032

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