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.
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.
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.
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.
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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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.
The authors declare no competing interests.
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