Longitudinal Asthma Phenotypes from Childhood to Middle-Age: A Population-based Cohort Study
Daniel J. Tan, Caroline Lodge, E. Haydn Walters, Adrian J. Lowe, Dinh Bui, Gayan Bowatte, Jonathan Pham, Bircan Erbas, Jennie Hui, Garun S. Hamilton, Paul S. Thomas, Mark Hew, George R. Washko, Richard Wood‐Baker, Michael J. Abramson, Jennifer L. Perret, Shyamali C. Dharmage
Abstract
Abstract Rationale Asthma is a heterogeneous condition, and longitudinal phenotyping may provide new insights into the origins and outcomes of the disease. Objectives We aimed to characterize the longitudinal phenotypes of asthma between the first and sixth decades of life in a population-based cohort study. Methods Respiratory questionnaires were collected at seven time points in the TAHS (Tasmanian Longitudinal Health Study) when participants were aged 7, 13, 18, 32, 43, 50, and 53 years. Current-asthma and ever-asthma status was determined at each time point, and group-based trajectory modeling was used to characterize distinct longitudinal phenotypes. Linear and logistic regression models were fitted to investigate associations of the longitudinal phenotypes with childhood factors and adult outcomes. Measurements and Main Results Of 8,583 original participants, 1,506 had reported ever asthma. Five longitudinal asthma phenotypes were identified: early-onset adolescent-remitting (40%), early-onset adult-remitting (11%), early-onset persistent (9%), late-onset remitting (13%), and late-onset persistent (27%). All phenotypes were associated with chronic obstructive pulmonary disease at age 53 years, except for late-onset remitting asthma (odds ratios: early-onset adolescent-remitting, 2.00 [95% confidence interval (CI), 1.13–3.56]; early-onset adult-remitting, 3.61 [95% CI, 1.30–10.02]; early-onset persistent, 8.73 [95% CI, 4.10–18.55]; and late-onset persistent, 6.69 [95% CI, 3.81–11.73]). Late-onset persistent asthma was associated with the greatest comorbidity at age 53 years, with increased risk of mental health disorders and cardiovascular risk factors. Conclusions Five longitudinal asthma phenotypes were identified between the first and sixth decades of life, including two novel remitting phenotypes. We found differential effects of these phenotypes on risk of chronic obstructive pulmonary disease and nonrespiratory comorbidities in middle age.