Resumo

PITE, Helena; PEREIRA, Ana Margarida; GASPAR, Ângela  e  MORAIS-ALMEIDA, Mário. Preschool wheezing phenotypes and its relation to asthma persistence until adolescence. Rev Port Imunoalergologia [online]. 2015, vol.23, n.3, pp.159-174. ISSN 0871-9721.

Introduction: Several preschool wheezing phenotypes have been proposed. In order to be clinically relevant, it is important to evaluate their application in clinical practice. Aims: To identify preschool wheezing phenotypes in a multidimensional statistical model, independent of predefined hypotheses, and to evaluate their prognosis regarding asthma persistence until adolescence. Methods: Prospective cohort study including 308 children with recurrent wheezing in preschool age, systematically evaluated at 3, 8 and 13 years of follow-up. Asthma prevalence was estimated at each time point. Risk factors associated with asthma persistence in adolescence were analyzed by multivariate logistic regression. K-means clusters analysis was used as the main clustering technique for identification of wheezing phenotypes, including variables obtained by medical questionnaire and skin prick tests. These phenotypes were compared for asthma prevalence, use of preventive treatment, spirometric parameters and bronchodilation tests results at school-age and adolescence. Results: Asthma prevalence was 58.3% (n=249) and 53.5% (n=170), at 8 and 13 years of follow-up, respectively. Having atopy (odds ratio (OR) [95% confidence interval]: 11.4 [3.8-34.4]) and rhinitis (OR 10.6 [3.7-29.8]) at preschool age were independent risk factors for asthma persistence in adolescence. We identified 3 preschool wheezing phenotypes, named “atopic persistent”, “non-atopic persistent” and “non-atopic transient”, which were predictive for asthma symptoms persistence and use of preventive treatment, in school-aged children and adolescents (p <0.001). Conclusions: This study revealed, for the first time in a cohort of children in Portugal, 3 preschool wheezing phenotypes. These phenotypes reconcile features of others previously described in the literature. Asthma persistence at school age and adolescence differed significantly between the groups

Palavras-chave : Asthma; children; cohort; phenotype; prognosis; wheezing.

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