Ten-Year Follow-up of Cluster-based Asthma Phenotypes in Adults. A Pooled Analysis of Three Cohorts
Résumé
Rationale: The temporal stability of adult asthma phenotypes iden- tified using clustering methods has never been addressed. Longitu- dinal cluster–based methods may provide novel insights in the study of the natural history of asthma.
Objectives: To compare the stability of cluster-based asthma pheno- type structures a decade apart in adults and to address the individ- uals’ phenotypic transition across these asthma phenotypes.
Methods: The latent transition analysis was applied on longitudinal data (twice, 10 yr apart) from 3,320 adults with asthma who took part in the European Community Respiratory Health Survey, the Swiss Co- hort Study on Air Pollution and Lung and Heart Diseases in Adults, or the Epidemiological Study on Genetics and Environment of Asthma. Nine variables covering personal and phenotypic characteristics mea- sured twice, 10 years apart, were simultaneously considered.
Measurements and Main Results: Latent transition analysis identifies seven asthma phenotypes (prevalence range, 8.4–20.8%), mainly characterized by the level of asthma symptoms (low, moderate, high), the allergic status, and pulmonary function. Phenotypes ob- served 10 years apart showed strong similarities. The probability of membership in the same asthma phenotype at both times varied across phenotypes from 54 to 88%. Different transition patterns were observed across phenotypes. Transitions toward increased asthma symptoms were more frequently observed among nonaller- gic phenotypes as compared with allergic phenotypes. Results showed a strong stability of the allergic status over time.
Conclusions: Adult asthma phenotypes identified by a clustering ap- proach, 10 years apart, were highly consistent. This study is the first to model the probabilities of transitioning over time between com- prehensive asthma phenotypes.
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