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Asthma trajectories from infancy up to young adulthood

Published online: June 1, 2021

The development of asthma is a dynamic process. For some patients, asthma starts early. For others, it debuts later in life. The disease may progress, remit, or relapse over time. Asthma has many underlying biological pathways that lead to different disease trajectories. The number of asthma trajectories previously identified and their specific patterns vary somewhat between populations and different lengths of follow-up. Unlike most prior studies, our present study provided the possibility to cover a period from infancy up to 24 years of age in a population-based cohort. This includes adolescence, which is a crucial period in the natural course of asthma. Investigating asthma trajectories provides a foundation for gaining increased knowledge on asthma development and associated markers, and disease outcomes can thereby be improved.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Ödling et al. identified and characterized trajectories of asthma from infancy to young adulthood as well as the association with lung function, inflammatory, and respiratory markers in adolescence and young adulthood using an unbiased data-driven approach, a latent class analysis (LCA). In the Swedish birth cohort, the LCA was performed in a total of 4,089 participants with data on asthma symptoms from infancy to the 24-year follow-up. The assessments of lung function, inflammatory, and respiratory markers were based on clinical data from the 16- and 24-year follow-ups.

In the population-based cohort, the unbiased LCA based on asthma symptom data from infancy to young adulthood resulted in 4 distinct asthma trajectories: never/infrequent, early-onset transient, adolescent-onset, and persistent asthma. These classifications of asthma trajectories provided insight about the origins and characteristics of asthma, as the adolescent-onset and persistent asthma trajectory groups seemed to have equal burdens of respiratory markers, such as asthma control and severity in adolescence and young adulthood. However, compared with the adolescent-onset trajectory group, the persistent asthma trajectory group showed more signs of lung function impairment in adolescence and young adulthood. Further, the 4 asthma trajectory groups showed differences in established background factors, allergic co-morbidity and immunoglobulin E sensitization.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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