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Predictive characteristics to discriminate the longitudinal outcomes of childhood asthma: a retrospective program-based study

Abstract

Background

Childhood asthma is an inflammatory disease with heterogeneous outcomes. We sought to determine the impact of total IgE, blood eosinophil, allergen sensitization, and inhaled corticosteroid (ICS) on longitudinal outcomes and to identify characteristics for discriminating different outcomes.

Methods

We conducted a retrospective study in 383 childhood asthma patients and another 313 patients with blood eosinophil data only receiving regular program-based visits from September 1, 2004, to December 31, 2018. Peak expiratory flow (PEF) variability, PEF predicted %, asthma severity, and asthma control at each visit were assessed as clinical outcomes.

Results

Our data show that the percentage of blood eosinophils was significantly associated with increased asthma severity (OR: 1.043, 95% CI: 1.002–1.086, P = 0.0392). Mold sensitization was significantly associated with asthma severity (OR: 2.2485, 95% CI: 1.3253–3.8150, P = 0.0027). Characteristics including sensitization status plus ICS dosage had the best area under the receiver operating characteristic curve (AUC) value for predicting longitudinal PEF predicted % (0.6609), PEF variability (0.6885), asthma severity (0.5918), and asthma control (0.6441), respectively.

Conclusions

We showed that the risk for adverse clinical outcomes at follow-up differed between serum IgE, blood eosinophil, and allergen sensitization identified at baseline. Sensitization and ICS dosage were predictive characteristics of long-term clinical outcomes.

Impact

  • The unique aspects of the study are its longitudinal assessment of patients receiving guideline-based asthma management program to help characterize the stability of the clinical outcomes over time. Characteristics including allergen sensitization and ICS dosage demonstrated an improved capability for distinguishing between better and worse clinical outcomes. Through longitudinal serial assessment, this study indicates the risk for adverse clinical outcomes differed between children with serum IgE/blood eosinophil/allergen sensitization characterized at baseline.

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Fig. 1: Schematic of study design
Fig. 2: Correlation between total serum IgE level and peripheral blood eosinophil percentage of 383 patients.
Fig. 3: Association of clinical characteristics on odds ratio (OR) of asthma outcomes.
Fig. 4: Predictive performance to discriminate the specific asthma outcomes of 383 children using clinical characteristics.

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Acknowledgements

We thank both Dr. Chin-Hao Chang, Ying-Ting Chao, Tse-Le Huang, and Yu-Han Chang from the Department of Medical Research, National Taiwan University Hospital, for invaluable assistance with statistical consultation, analysis, and model development/validation.

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Authors and Affiliations

Authors

Contributions

J.-H.L. conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and carefully revised the manuscript. A.-L.C., S.-Y.H., and K.-Y.C. collected data, carried out the initial interpretation, and reviewed and revised the manuscript. B.-L.C., Y.-H.Y., Y.-T.L., L.-C.W., H.-H.Y., and Y.-C.H. supervised data interpretation, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Jyh-Hong Lee.

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Competing interests

The authors declare no competing interests.

Consent statement

This study was conducted in compliance with the protocol for good clinical practices and the principles of the Declaration of Helsinki. The informed consents were obtained from all participants and/or their legal guardians.

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Lee, JH., Lin, YT., Chu, AL. et al. Predictive characteristics to discriminate the longitudinal outcomes of childhood asthma: a retrospective program-based study. Pediatr Res 92, 1357–1363 (2022). https://doi.org/10.1038/s41390-022-01956-6

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  • DOI: https://doi.org/10.1038/s41390-022-01956-6

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