Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique, Institut Armand-Frappier, Université du Québec, Laval, Quebec, Canada.
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Ann Allergy Asthma Immunol. 2019 Jan;122(1):50-57.e2. doi: 10.1016/j.anai.2018.09.453. Epub 2018 Sep 14.
Many previous studies on asthma phenotypes were conducted in selected clinical populations and overlooked changes throughout the life course.
To identify asthma phenotypes based on use of health services for allergic diseases in 3 life periods and document transitions among phenotypes across life periods.
In a population-based cohort of 78,211 individuals born in 1974 in the province of Québec, Canada, we documented medical visits and hospitalizations for asthma and other allergic diseases until 1994. Phenotypes based on clusters of health services use in childhood (8-12 years of age), adolescence (13-17 years of age), and young adulthood (18-20 years of age) were identified using a hierarchical method among 9,989 individuals (12.8%) who had at least one health encounter for asthma during follow-up. Population-level probabilities of transitioning among phenotypes were estimated in the full study population.
In the subset with asthma, 6 phenotypes were identified during both childhood and young adulthood and 7 during adolescence. The most common phenotype was no asthma or allergic diseases: 58% in childhood, 42% in adolescence, and 54% in adulthood. The second most common was the mild asthma and no allergic diseases phenotype, representing 36%, 31%, and 21%, respectively, in these 3 periods. In the study population, 87% of the individuals remained in the no asthma phenotype group during the follow-up. Most individuals in the asthma phenotypes transitioned over time.
Our study uniquely contributes to a better understanding, at the population level, of the manifestations and transitions in asthma phenotypes during the life course.
许多先前关于哮喘表型的研究都是在选定的临床人群中进行的，忽略了整个生命过程中的变化。
根据在三个生命阶段使用过敏疾病的健康服务来确定哮喘表型，并记录各表型在生命阶段之间的转变。
在加拿大魁北克省 1974 年出生的一个基于人群的队列中，我们记录了哮喘和其他过敏疾病的医疗就诊和住院情况，直至 1994 年。在至少有一次哮喘随访期间健康接触的 9989 个人（12.8%）中，使用分层方法确定了基于健康服务使用聚类的表型，这些聚类出现在儿童期（8-12 岁）、青春期（13-17 岁）和青年期（18-20 岁）。在整个研究人群中估计了各表型之间的人群水平转变概率。
在有哮喘的亚组中，6 种表型在儿童期和青年期都有出现，7 种表型在青春期出现。最常见的表型是无哮喘或过敏疾病：儿童期占 58%，青春期占 42%，成年期占 54%。其次常见的是轻度哮喘且无过敏疾病表型，分别在这三个时期占 36%、31%和 21%。在研究人群中，87%的个体在随访期间仍保持无哮喘表型组。大多数哮喘表型的个体随时间发生转变。
我们的研究在人群水平上对哮喘表型在生命过程中的表现和转变有了更好的理解，这是独特的贡献。
