Novel trajectories for identifying asthma phenotypes: a longitudinal study in Korean asthma cohort, COREA

Publication date: Available online 19 February 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): So Young Park, Hee Won Jung, Jae Moon Lee, Bomi Shin, Hyo Jung Kim, Min-Hye Kim, Woo-Jung Song, Hyouk-Soo Kwon, Jae-Woo Jung, Sae-Hoon Kim, Heung-Woo Park, An-Soo Jang, Yoon-Seok Chang, You Sook Cho, Young-Joo Cho, Sang-Heon Cho, Byoung Whui Choi, Sun Ju Lee, Sun Ha Jee, Sung Kyoung Choi

Abstract

Background

Unbiased cluster analysis has identified several asthma phenotypes. However, these phenotypes did not consistently predict disease prognosis and reflect temporal variability of airway inflammation.

Objective

We aimed to identify longitudinal trajectories in terms of pulmonary function parameters and investigated whether the trajectories are associated with prognosis.

Methods

Data was extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA). Three-year pulmonary function test results were utilized to apply finite mixture models for group-based trajectory in 486 patients with eligible dataset.

Results

Two main sets of longitudinal trajectories were identified in terms of FEV₁% predicted, and FEV₁ variability. In the four trajectories determined with FEV₁% predicted, the pulmonary function showed a consistent course in four stratified levels during three years of follow up, which was associated with unexpected hospital visits and the use of steroid bursts due to exacerbation. The variability of pulmonary function showed three different patterns and we found that higher blood and sputum eosinophils was associated with the higher variability of pulmonary function and more exacerbations.

Conclusion

Trajectory analysis is a novel method that provides longitudinal asthma phenotypes and aids in prediction of future risk of exacerbation. Further analysis is needed to validate the usefulness of these trajectories in an independent population.

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