Pathophysiological characterization of asthma transitions across adolescence
Pathophysiological characterization of asthma transitions across adolescence
BACKGROUND: Adolescence is a period of change, which coincides with disease remission in a significant proportion of subjects with childhood asthma. There is incomplete understanding of the changing characteristics underlying different adolescent asthma transitions. We undertook pathophysiological characterization of transitional adolescent asthma phenotypes in a longitudinal birth cohort.
METHODS: The Isle of Wight Birth Cohort (N = 1456) was reviewed at 1, 2, 4, 10 and 18-years. Characterization included questionnaires, skin tests, spirometry, exhaled nitric oxide, bronchial challenge and (in a subset of 100 at 18-years) induced sputum. Asthma groups were "never asthma" (no asthma since birth), "persistent asthma" (asthma at age 10 and 18), "remission asthma" (asthma at age 10 but not at 18) and "adolescent-onset asthma" (asthma at age 18 but not at age 10).
RESULTS: Participants whose asthma remitted during adolescence had lower bronchial reactivity (odds ratio (OR) 0.30; CI 0.10 -0.90; p = 0.03) at age 10 plus greater improvement in lung function (forced expiratory flow 25-75% gain: 1.7 L; 1.0-2.9; p = 0.04) compared to persistent asthma by age 18. Male sex (0.3; 0.1-0.7; p < 0.01) and lower acetaminophen use (0.4; 0.2-0.8; p < 0.01) independently favoured asthma remission, when compared to persistent asthma. Asthma remission had a lower total sputum cell count compared to never asthma (31.5 [25-75 centiles] 12.9-40.4) vs. 47.0 (19.5-181.3); p = 0.03). Sputum examination in adolescent-onset asthma showed eosinophilic airway inflammation (3.0%, 0.7-6.6), not seen in persistent asthma (1.0%, 0-3.9), while remission group had the lowest sputum eosinophil count (0.3%, 0-1.4) and lowest eosinophils/neutrophils ratio of 0.0 (Interquartile range: 0.1).
CONCLUSION: Asthma remission during adolescence is associated with lower initial BHR and greater gain in small airways function, while adolescent-onset asthma is primarily eosinophilic.
Adolescent, Age of Onset, Asthma/diagnosis, Child, Child, Preschool, Cohort Studies, Disease Progression, Female, Humans, Infant, Logistic Models, Lung/immunology, Male, Multivariate Analysis, Odds Ratio, Phenotype, Prognosis, Remission Induction, Respiratory Function Tests, Risk Factors, Severity of Illness Index, United Kingdom/epidemiology
Arshad, Syed Hasan
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Raza, Abid
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Lau, Laurie
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Bawakid, Khalid
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Karmaus, Wilfried
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Zhang, Hongmei
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Ewart, Susan
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Patil, Veersh
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Roberts, Graham
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Kurukulaaratchy, Ramesh
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29 November 2014
Arshad, Syed Hasan
917e246d-2e60-472f-8d30-94b01ef28958
Raza, Abid
0bcd5946-167e-4e75-9eaf-906e980ee498
Lau, Laurie
2af8045d-6162-4939-aba7-28dd2f60f6a8
Bawakid, Khalid
e88d869b-fa38-42ba-8235-be8aa40a592d
Karmaus, Wilfried
281d0e53-6b5d-4d38-9732-3981b07cd853
Zhang, Hongmei
9f774048-54d6-4321-a252-3887b2c76db0
Ewart, Susan
28667421-3cf7-43d7-b1c3-ca27564938f7
Patil, Veersh
014d9ce2-15f4-4981-a6f3-8e6dc3f49e42
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Kurukulaaratchy, Ramesh
9c7b8105-2892-49f2-8775-54d4961e3e74
Arshad, Syed Hasan, Raza, Abid, Lau, Laurie, Bawakid, Khalid, Karmaus, Wilfried, Zhang, Hongmei, Ewart, Susan, Patil, Veersh, Roberts, Graham and Kurukulaaratchy, Ramesh
(2014)
Pathophysiological characterization of asthma transitions across adolescence.
Respiratory Research, 15 (1), [153].
(doi:10.1186/s12931-014-0153-7).
Abstract
BACKGROUND: Adolescence is a period of change, which coincides with disease remission in a significant proportion of subjects with childhood asthma. There is incomplete understanding of the changing characteristics underlying different adolescent asthma transitions. We undertook pathophysiological characterization of transitional adolescent asthma phenotypes in a longitudinal birth cohort.
METHODS: The Isle of Wight Birth Cohort (N = 1456) was reviewed at 1, 2, 4, 10 and 18-years. Characterization included questionnaires, skin tests, spirometry, exhaled nitric oxide, bronchial challenge and (in a subset of 100 at 18-years) induced sputum. Asthma groups were "never asthma" (no asthma since birth), "persistent asthma" (asthma at age 10 and 18), "remission asthma" (asthma at age 10 but not at 18) and "adolescent-onset asthma" (asthma at age 18 but not at age 10).
RESULTS: Participants whose asthma remitted during adolescence had lower bronchial reactivity (odds ratio (OR) 0.30; CI 0.10 -0.90; p = 0.03) at age 10 plus greater improvement in lung function (forced expiratory flow 25-75% gain: 1.7 L; 1.0-2.9; p = 0.04) compared to persistent asthma by age 18. Male sex (0.3; 0.1-0.7; p < 0.01) and lower acetaminophen use (0.4; 0.2-0.8; p < 0.01) independently favoured asthma remission, when compared to persistent asthma. Asthma remission had a lower total sputum cell count compared to never asthma (31.5 [25-75 centiles] 12.9-40.4) vs. 47.0 (19.5-181.3); p = 0.03). Sputum examination in adolescent-onset asthma showed eosinophilic airway inflammation (3.0%, 0.7-6.6), not seen in persistent asthma (1.0%, 0-3.9), while remission group had the lowest sputum eosinophil count (0.3%, 0-1.4) and lowest eosinophils/neutrophils ratio of 0.0 (Interquartile range: 0.1).
CONCLUSION: Asthma remission during adolescence is associated with lower initial BHR and greater gain in small airways function, while adolescent-onset asthma is primarily eosinophilic.
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s12931-014-0153-7
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Accepted/In Press date: 13 November 2014
e-pub ahead of print date: 29 November 2014
Published date: 29 November 2014
Keywords:
Adolescent, Age of Onset, Asthma/diagnosis, Child, Child, Preschool, Cohort Studies, Disease Progression, Female, Humans, Infant, Logistic Models, Lung/immunology, Male, Multivariate Analysis, Odds Ratio, Phenotype, Prognosis, Remission Induction, Respiratory Function Tests, Risk Factors, Severity of Illness Index, United Kingdom/epidemiology
Identifiers
Local EPrints ID: 431038
URI: http://eprints.soton.ac.uk/id/eprint/431038
ISSN: 1465-9921
PURE UUID: 8d00210e-d516-44a7-8999-521544eb747a
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Date deposited: 22 May 2019 16:30
Last modified: 16 Mar 2024 03:44
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Contributors
Author:
Abid Raza
Author:
Laurie Lau
Author:
Khalid Bawakid
Author:
Wilfried Karmaus
Author:
Hongmei Zhang
Author:
Susan Ewart
Author:
Veersh Patil
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