Danielle C M Belgrave1, Angela Simpson2, Aida Semic-Jusufagic2, Clare S Murray2, Iain Buchan3, Andrew Pickles4, Adnan Custovic2. 1. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom; Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom. Electronic address: danielle.belgrave@manchester.ac.uk. 2. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom. 3. Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom. 4. Department of Biostatistics, King's College London, London, United Kingdom.
Abstract
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.
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.
Authors: Adnan Custovic; Danielle Belgrave; Lijing Lin; Eteri Bakhsoliani; Aurica G Telcian; Roberto Solari; Clare S Murray; Ross P Walton; John Curtin; Michael R Edwards; Angela Simpson; Magnus Rattray; Sebastian L Johnston Journal: Am J Respir Crit Care Med Date: 2018-05-15 Impact factor: 21.405
Authors: Danielle C M Belgrave; Iain Buchan; Christopher Bishop; Lesley Lowe; Angela Simpson; Adnan Custovic Journal: Am J Respir Crit Care Med Date: 2014-05-01 Impact factor: 21.405
Authors: Matthew C Altman; Agustin Calatroni; Sima Ramratnam; Daniel J Jackson; Scott Presnell; Mario G Rosasco; Peter J Gergen; Leonard B Bacharier; George T O'Connor; Megan T Sandel; Meyer Kattan; Robert A Wood; Cynthia M Visness; James E Gern Journal: J Allergy Clin Immunol Date: 2021-03-10 Impact factor: 10.793
Authors: Simon M Collin; Raquel Granell; Carri Westgarth; Jane Murray; Elizabeth S Paul; Jonathan A C Sterne; A John Henderson Journal: PLoS One Date: 2015-06-10 Impact factor: 3.240
Authors: Danielle C M Belgrave; Raquel Granell; Angela Simpson; John Guiver; Christopher Bishop; Iain Buchan; A John Henderson; Adnan Custovic Journal: PLoS Med Date: 2014-10-21 Impact factor: 11.069
Authors: Mattia C F Prosperi; Umit M Sahiner; Danielle Belgrave; Cansin Sackesen; Iain E Buchan; Angela Simpson; Tolga S Yavuz; Omer Kalayci; Adnan Custovic Journal: Am J Respir Crit Care Med Date: 2013-12-01 Impact factor: 21.405