RECENT ADVANCESAsthma phenotypes in childhood: lessons from an epidemiological approach
Section snippets
COHORT STUDIES AND ASTHMA FOLLOW-UP FROM CHILDHOOD TO ADULTHOOD
The recent publication of adequately powered, well-designed longitudinal studies with follow-up starting during the first years of life has produced a remarkable change in our understanding of asthma, its beginnings, its clinical expression and its evolution.
A recent study by Sears et al.7 evaluated a cohort from Dunedin, New Zealand, followed from 9 to 26 years of age with questionnaires, pulmonary function tests, bronchial challenge testing and allergy testing. The authors defined wheezing as
ASTHMA PHENOTYPES
These wheezing syndromes are characterised by the persistence or remittance of wheeze and wheeze-associated symptoms from childhood to adulthood. We have proposed that three can be defined based on specific characteristics: transient early wheezers (wheezing up to 3–5 years of age but not thereafter), non-atopic wheezing and IgE-mediated wheezing/asthma (Fig. 3).
PRACTICE POINTS
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Asthma is a heterogeneous disease with well recognized wheeze phenotypes in childhood.
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Wheezing in the first years of life is not associated with atopy, and is thus called transient wheezing. It is known to be associated with diminished lung function.
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A group of asthmatic children who are still symptomatic with episodes of wheezing up to adolescence do present a milder form of disease, associated with RSV and not with atopy, i.e., non-atopic wheezers.
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Persistent wheezing, the ‘classic’ asthma is
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