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Published on: November 4, 2010
Asthma severity in childhood, untangling clinical phenotypes
Astri Lang1, Petter Mowinckel, Christine Sachs-Olsen
1Department of Pediatrics, Oslo University Hospital, Oslo, Norway. astrima@online.no
Summary
Childhood asthma presents differently. Chronic persistent asthma symptoms, unlike exacerbation-focused symptoms, indicate poorer lung function and quality of life in children, suggesting distinct asthma phenotypes.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Childhood asthma severity and control are complex, with poorly understood links between symptom patterns and objective measures.
- Problematic severe asthma is defined by uncontrolled symptoms despite high-dose inhaled corticosteroid (HD-ICS) and other controller medications.
Purpose of the Study:
- To investigate distinct phenotypes of childhood asthma based on symptom patterns and objective measurements.
- To compare objective asthma markers between children with chronic persistent symptoms, exacerbation-predominant symptoms, and well-controlled asthma.
Main Methods:
- 115 asthmatic schoolchildren were studied, with 31 classified as having Problematic severe asthma.
- Two subgroups of uncontrolled asthma were defined: Exacerbations and Chronic persistent asthma.
- Objective measures including lung function, exhaled nitric oxide (FE(NO)), allergic sensitization, and Quality of Life (QoL) were compared across groups using multifactor analysis.
Main Results:
- The Chronic persistent asthma subgroup showed reduced lung function, increased immunoglobulin E (IgE), poly-sensitization, and impaired QoL, similar to Problematic severe asthma.
- The Exacerbations subgroup had objective features comparable to well-controlled asthma.
- Chronic asthma symptoms significantly explained reduced lung function, QoL, and increased FE(NO).
Conclusions:
- Children with Chronic persistent asthma and those symptomatic mainly during exacerbations may represent distinct phenotypes.
- These phenotypes likely have different clinical prognoses, impacting treatment strategies and long-term outcomes.
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