Joint modeling of parentally reported and physician-confirmed wheeze identifies children with persistent troublesome wheezing
Open accessAbstract
Background Previous studies have suggested the presence of different childhood wheeze phenotypes through statistical modeling based on parentally reported wheezing.Objective We sought to investigate whether joint modeling of observations from both medical records and parental reports helps to more accurately define wheezing disorders during childhood and whether incorporating information from medical records better characterizes severity.Methods In a population-based birth cohort (n = 1184), we analyzed data from 2 sources (parentally reported current wheeze at 4 follow-ups and physician-confirmed wheeze from medical records in each year from birth to age 8 years) to determine classes of children who differ in wheeze trajectories. We tested the validity of these classes by examining their relationships with objective outcomes (lung function, airway hyperreactivity, and atopy), asthma medication, and severe exacerbations.Results Longitudinal latent class modeling identified a 5-class model that best described the data. We assigned classes as follows: no wheezing (53.3%), transient early wheeze (13.7%), late-onset wheeze (16.7%), persistent controlled wheeze (13.1%), and persistent troublesome wheeze (PTW; 3.2%). Longitudinal trajectories of atopy and lung function differed significantly between classes. Patients in the PTW class had diminished lung function and more hyperreactive airways compared with all other classes. We observed striking differences in exacerbations, hospitalizations, and unscheduled visits, all of which were markedly higher in patients in the PTW class compared with those in the other classes. For example, the risk of exacerbation was much higher in patients in the PTW class compared with patients with persistent controlled wheeze (odds ratio [OR], 3.58; 95% CI, 1.27-10.09), late-onset wheeze (OR, 15.92; 95% CI, 5.61-45.15), and transient early wheeze (OR, 12.24; 95% CI, 4.28-35.03).Conclusion We identified a novel group of children with persistent troublesome wheezing, who have markedly different outcomes compared with persistent wheezers with controlled disease.
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A Manchester birth cohort identified a latent class of persistent troublesome wheezers, comprising children with high number of acute asthma attacks, hospital admissions, and unscheduled healthcare visits, which accounted for approximately 10% of children with doctor-diagnosed asthma and 3.2% of the general population.
“A study conducted within a birth cohort in Manchester (UK), identified a latent class of persistent troublesome wheezers, comprising children with high number of acute asthma attacks, hospital admissions, and unscheduled healthcare visits, which accounted for ~10% of children with doctor-diagnosed asthma, and 3.2% of the general population (44).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [44]
These children exhibited numerous features associated with severe asthma including diminished lung function, high FeNO and hyperreactive airways, with a significant loss of lung function between preschool and mid-school age.
“These children exhibited numerous features associated with severe asthma including diminished lung function, high FeNO and hyperreactive airways (44), with a significant loss of lung function between preschool and mid-school age (45).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [44]
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References 36 · Cited by 98
Research works printed but not linked: 2
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- Authors
- Belgrave, D. C. M., Simpson, A., Semic-Jusufagic, A., Murray, C. S., Buchan, I., Pickles, A., & Custovic, A.
- Affiliations
- University of Manchester (GB)
- King's College London (GB)
- Corresponding author
- Belgrave, Danielle C.M.
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 132
- Issue
- 3
- Pages
- 575-583.e12
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2077820409
- Cited by
- 98
- References
- 36
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 5 · 2021: 8 · 2020: 8 · 2019: 9 · 2018: 11 · 2017: 7 · 2016: 6 · 2015: 10 · 2014: 7 · 2013: 3
- FWCI
- 6.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Funders
- GlaxoSmithKline
- National Institute for Health and Care Research
- Asthma and Lung UK (04/014)
- Medical Research Council (MR/K002449/1, G0601361, MR/K006665/1, MC_PC_13042)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- childhood wheezing, wheeze phenotypes, lung function, airway hyperresponsiveness, atopy, asthma exacerbations, hospitalization, asthma treatment, unscheduled visits, birth cohort
- MeSH terms
- Allergens, Child, Child, Preschool, Female, Humans, Hypersensitivity, Immediate, Immunoglobulin E, Infant, Male, Models, Biological, Parents, Physicians, Surveys and Questionnaires, Respiratory Sounds, Spirometry, Bronchial Hyperreactivity
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