How many types of ‘asthma’ exist in children?

Published Online: April 20, 2016

Asthma is not a single disease; the underlying causes, symptoms and triggers, and how patients respond to treatment all differ between individuals. One of the main symptoms associated with asthma is wheezing. Studying the natural history of wheezing can help disentangle the different sub-types of asthma and identify which children are at higher risk of developing a more severe, persistent condition.

In a paper published in The Journal of Allergy & Clinical Immunology (JACI), Granell and colleagues used a mathematical modeling approach (latent class analysis) to identify distinct wheezing groups based on wheezing reports from birth to 16½ years among 12,303 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK.

The different wheezing groups were then compared in terms of gender, allergic status at 7½ years, lung function measures, bronchodilator reversibility (BDR), and concentration of nitric oxide (FeNO) at 14-15 years which can help identify airway inflammation.

The Bristol based researchers identified six distinct wheezing groups: two remittent (pre-school onset and mid-childhood onset), three persistent (school-age onset, late-childhood onset and continuous), and a never/infrequent wheeze group. The persistent wheeze groups had more children with allergy and were associated with BDR, higher levels of FeNO and low lung function when compared to the children with infrequent or no wheeze. Children with pre-school wheezing that remits before the age of 4 years had no BDR and normal FeNO levels in adolescence. Boys in the school-age onset persisting group, with wheeze starting after 3½ years, were more likely to remit during adolescence when compared to girls in the same group.

Wheeze starting before the age of 4 years and persisting to adolescence has been identified as the group of children most strongly associated with airway obstruction in adolescence. Future work should focus on developing early prediction tools combining biological and genetic markers to identify these children which are the clearest target group for interventions.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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