Yoon Jisun, Yang Hyeon-Jong, Rhee Eun Hee, Lee Eun, Park Ji Soo, Jung Sungsu, Kim Kyunghoon, Kim Hwan Soo, Baek Hey-Sung, Kim Woo Kyung, Yoo Young, Suh Dong In, Shin Meeyong, Kwon Ji Won, Jang Gwang Cheon, Seo Ju-Hee, Woo Sung Il, Kim Hyung Young, Shin Youn Ho, Lee Ju Suk, Kim Jin Tack, Lim Dae Hyun, Lee Seung-Won, Song Dae Jin, Yu Jinho
Department of Pediatrics, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
Clinical Research Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Allergy Asthma Immunol Res. 2025 Jan;17(1):47-59. doi: 10.4168/aair.2025.17.1.47.
Studies on the longitudinal clinical features of asthma or allergic comorbidities in children are limited. We aimed to examine the trajectories of asthma and allergic comorbidities and determine whether these trajectories differ according to clinical asthma phenotypes from birth to adolescence.
We enrolled 958 children with physician-diagnosed asthma from the Korean childhood Asthma Study (KAS) cohort. Children with asthma were classified using hierarchical cluster analysis. Information on the diagnosis and treatment of allergic diseases before cohort entry was collected through linkage with national claims data from the Health Insurance Review and Assessment Service.
In the KAS cohort, approximately half had a history of atopic dermatitis (AD) before infancy, with its prevalence gradually decreasing during adolescence. The prevalence of allergic rhinitis (AR) increased with age. The prevalence of asthma increased during early childhood and decreased during adolescence. According to the natural progression of asthma, AD, and AR trajectories, 4 distinctive phenotypes were identified using latent class analysis: "almost controlled," "early-onset asthma with AD and late-onset AR," "early-onset asthma only," and "intermediate-onset asthma and late-onset AR." Four distinct clinical trajectory patterns of asthma, AD, and AR were identified among the 4 cluster phenotypes based on baseline characteristics. Cluster 1 comprised male-dominant, atopic asthma with early-onset AD and late-onset AR. Cluster 2 included early-onset, atopic asthma with AD" persistent into adolescence. Cluster 3 encompassed "puberty-onset, female-dominant atopic asthma" with early-onset and low remission rates. Cluster 4 comprised "early-onset asthma with less atopic features" and the lowest comorbidities of AD and AR.
The longitudinal trajectories of asthma and allergic comorbidities in Korean children can be classified into distinct clusters. Most phenotypes exhibited early-onset asthma with a varying prevalence of comorbidities. The persistence of AD, rather than its onset age, determines the phenotype.
关于儿童哮喘或过敏性合并症纵向临床特征的研究有限。我们旨在研究哮喘和过敏性合并症的发展轨迹，并确定这些轨迹是否因从出生到青春期的临床哮喘表型而异。
我们纳入了来自韩国儿童哮喘研究（KAS）队列中958名经医生诊断为哮喘的儿童。使用层次聚类分析对哮喘儿童进行分类。通过与健康保险审查和评估服务机构的国家索赔数据建立联系，收集队列入组前过敏性疾病的诊断和治疗信息。
在KAS队列中，约一半儿童在婴儿期前有特应性皮炎（AD）病史，其患病率在青春期逐渐下降。过敏性鼻炎（AR）的患病率随年龄增长而增加。哮喘患病率在幼儿期增加，在青春期下降。根据哮喘、AD和AR轨迹的自然发展过程，使用潜在类别分析确定了4种不同的表型：“几乎得到控制”、“伴有AD的早发性哮喘和迟发性AR”、“仅早发性哮喘”以及“中度发作哮喘和迟发性AR”。基于基线特征，在4种聚类表型中确定了哮喘、AD和AR的4种不同临床轨迹模式。聚类1包括以男性为主、伴有早发性AD和迟发性AR的特应性哮喘。聚类2包括早发性、伴有持续至青春期的AD的特应性哮喘。聚类3涵盖“青春期发作、以女性为主的特应性哮喘”，具有早发性和低缓解率。聚类4包括“具有较少特应性特征的早发性哮喘”以及AD和AR合并症最低的情况。
韩国儿童哮喘和过敏性合并症的纵向轨迹可分为不同的聚类。大多数表型表现为早发性哮喘，合并症患病率各不相同。AD的持续存在而非发病年龄决定了表型。
