Classification of childhood asthma phenotypes and long-term clinical responses to inhaled anti-inflammatory medications.
J Allergy Clin Immunol
; 133(5): 1289-300, 1300.e1-12, 2014 May.
Article
en En
| MEDLINE
| ID: mdl-24892144
ABSTRACT
BACKGROUND:
Although recent studies have identified the presence of phenotypic clusters in asthmatic patients, the clinical significance and temporal stability of these clusters have not been explored.OBJECTIVE:
Our aim was to examine the clinical relevance and temporal stability of phenotypic clusters in children with asthma.METHODS:
We applied spectral clustering to clinical data from 1041 children with asthma participating in the Childhood Asthma Management Program. Posttreatment randomization follow-up data collected over 48 months were used to determine the effect of these clusters on pulmonary function and treatment response to inhaled anti-inflammatory medication.RESULTS:
We found 5 reproducible patient clusters that could be differentiated on the basis of 3 groups of features atopic burden, degree of airway obstruction, and history of exacerbation. Cluster grouping predicted long-term asthma control, as measured by the need for oral prednisone (P < .0001) or additional controller medications (P = .001), as well as longitudinal differences in pulmonary function (P < .0001). We also found that the 2 clusters with the highest rates of exacerbation had different responses to inhaled corticosteroids when compared with the other clusters. One cluster demonstrated a positive response to both budesonide (P = .02) and nedocromil (P = .01) compared with placebo, whereas the other cluster demonstrated minimal responses to both budesonide (P = .12) and nedocromil (P = .56) compared with placebo.CONCLUSION:
Phenotypic clustering can be used to identify longitudinally consistent and clinically relevant patient subgroups, with implications for targeted therapeutic strategies and clinical trials design.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fenotipo
/
Asma
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Prednisolona
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Nedocromil
/
Budesonida
/
Antiinflamatorios
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Child
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Child, preschool
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Female
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Humans
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Male
Idioma:
En
Revista:
J Allergy Clin Immunol
Año:
2014
Tipo del documento:
Article