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Open AccessArticle

Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies

by
Rita Amaral
1,2,3,4,*,
Cristina Jácome
1,2,
Rute Almeida
1,2,
Ana Margarida Pereira
1,2,5,
Magna Alves-Correia
5,
Sandra Mendes
1,
José Carlos Cidrais Rodrigues
6,
Joana Carvalho
6,
Luís Araújo
5,
Alberto Costa
7,
Armandina Silva
7,
Maria Fernanda Teixeira
8,
Manuel Ferreira-Magalhães
2,8,
Rodrigo Rodrigues Alves
9,
Ana Sofia Moreira
10,
Ricardo M. Fernandes
11,
Rosário Ferreira
11,
Paula Leiria Pinto
12,
Nuno Neuparth
12,13,
Diana Bordalo
14,
Ana Todo Bom
15,
Maria José Cálix
16,
Tânia Ferreira
17,
Joana Gomes
18,
Carmen Vidal
19,
Ana Mendes
11,
Maria João Vasconcelos
20,
Pedro Morais Silva
21,
José Ferraz
22,
Ana Morête
23,
Claúdia Sofia Pinto
24,
Natacha Santos
25,
Claúdia Chaves Loureiro
26,
Ana Arrobas
27,
Maria Luís Marques
28,
Carlos Lozoya
29,
Cristina Lopes
6,30,
Francisca Cardia
31,
Carla Chaves Loureiro
32,
Raquel Câmara
33,
Inês Vieira
34,
Sofia da Silva
35,
Eurico Silva
36,
Natalina Rodrigues
37 and
João A. Fonseca
1,2,5
1
Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
2
Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
3
Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
4
Department of Women’s and Children’s Health, Paediatric Research, Uppsala University, SE-751 05 Uppsala, Sweden
5
Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal
6
Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal
7
Serviço de Pediatria, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
8
Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
9
Serviço de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
10
Unidade de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
11
Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal
12
Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisboa, Portugal
13
Pathophysiology, CHRC/CEDOC, High Burden and High Mortality Diseases Thematic Line Coordinator, Nova Medical School, 1150-190 Lisboa, Portugal
14
Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, 4780-371 Vila Nova de Famalicão, Portugal
15
Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
16
Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela–Viseu, 3504-509 Viseu, Portugal
17
Unidade de Saúde Familiar Progresso e Saúde, ACeS Baixo Mondego, 3060-716 Tocha, Portugal
18
Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
19
Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, 15706 Santiago De Compostela, Spain
20
Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, 4200–319 Porto, Portugal
21
Imunoalergologia, Grupo HPA Saúde, 8500-322 Portimão, Portugal
22
Imunoalergologia, Hospital Privado de Alfena, Trofa Saúde, 4445-243 Alfena, Portugal
23
Serviço de Imunoalergologia, Hospital Infante D. Pedro, Centro Hospitalar Baixo Vouga, 3814-501 Aveiro, Portugal
24
Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, 5000-508 Vila Real, Portugal
25
Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, 8000-386 Portimão, Portugal
26
Serviço de Pneumologia, Hospitais da Universidade de Coimbra, 3000-076 Coimbra, Portugal
27
Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
28
Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
29
Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal
30
Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
31
Unidade de Saúde Familiar Terras de Azurara, ACES Dão Lafões, 3530-113 Mangualde, Portugal
32
Departamento de Pediatria, Serviço de Pediatria Ambulatória, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
33
Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, 2834-003 Barreiro, Portugal
34
UCSP Dr. Arnaldo Sampaio, ACES Pinhal Litoral, 2419-014 Leiria, Portugal
35
USF Cuidarte, Unidade Local de Saúde do Alto Minho, 4925-083 Portuzelo, Portugal
36
Unidade de Saúde Familiar João Semana, ACeS Baixo Vouga, 3880-225 Ovar, Portugal
37
Unidade de Saúde Familiar Mondego, ACES Baixo Mondego, 3045-059 Coimbra, Portugal
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(3), 1015; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031015
Received: 13 December 2020 / Revised: 18 January 2021 / Accepted: 20 January 2021 / Published: 24 January 2021
(This article belongs to the Special Issue Diagnosis and Prevention of Asthma in Children)
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Abstract

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13–17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk. View Full-Text
Keywords: asthma; adolescents; phenotypes; clustering; longitudinal studies; latent class analysis asthma; adolescents; phenotypes; clustering; longitudinal studies; latent class analysis
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MDPI and ACS Style

Amaral, R.; Jácome, C.; Almeida, R.; Pereira, A.M.; Alves-Correia, M.; Mendes, S.; Rodrigues, J.C.C.; Carvalho, J.; Araújo, L.; Costa, A.; Silva, A.; Teixeira, M.F.; Ferreira-Magalhães, M.; Alves, R.R.; Moreira, A.S.; Fernandes, R.M.; Ferreira, R.; Pinto, P.L.; Neuparth, N.; Bordalo, D.; Bom, A.T.; Cálix, M.J.; Ferreira, T.; Gomes, J.; Vidal, C.; Mendes, A.; Vasconcelos, M.J.; Silva, P.M.; Ferraz, J.; Morête, A.; Pinto, C.S.; Santos, N.; Loureiro, C.C.; Arrobas, A.; Marques, M.L.; Lozoya, C.; Lopes, C.; Cardia, F.; Loureiro, C.C.; Câmara, R.; Vieira, I.; Silva, S.d.; Silva, E.; Rodrigues, N.; Fonseca, J.A. Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies. Int. J. Environ. Res. Public Health 2021, 18, 1015. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031015

AMA Style

Amaral R, Jácome C, Almeida R, Pereira AM, Alves-Correia M, Mendes S, Rodrigues JCC, Carvalho J, Araújo L, Costa A, Silva A, Teixeira MF, Ferreira-Magalhães M, Alves RR, Moreira AS, Fernandes RM, Ferreira R, Pinto PL, Neuparth N, Bordalo D, Bom AT, Cálix MJ, Ferreira T, Gomes J, Vidal C, Mendes A, Vasconcelos MJ, Silva PM, Ferraz J, Morête A, Pinto CS, Santos N, Loureiro CC, Arrobas A, Marques ML, Lozoya C, Lopes C, Cardia F, Loureiro CC, Câmara R, Vieira I, Silva Sd, Silva E, Rodrigues N, Fonseca JA. Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies. International Journal of Environmental Research and Public Health. 2021; 18(3):1015. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031015

Chicago/Turabian Style

Amaral, Rita; Jácome, Cristina; Almeida, Rute; Pereira, Ana M.; Alves-Correia, Magna; Mendes, Sandra; Rodrigues, José C.C.; Carvalho, Joana; Araújo, Luís; Costa, Alberto; Silva, Armandina; Teixeira, Maria F.; Ferreira-Magalhães, Manuel; Alves, Rodrigo R.; Moreira, Ana S.; Fernandes, Ricardo M.; Ferreira, Rosário; Pinto, Paula L.; Neuparth, Nuno; Bordalo, Diana; Bom, Ana T.; Cálix, Maria J.; Ferreira, Tânia; Gomes, Joana; Vidal, Carmen; Mendes, Ana; Vasconcelos, Maria J.; Silva, Pedro M.; Ferraz, José; Morête, Ana; Pinto, Claúdia S.; Santos, Natacha; Loureiro, Claúdia C.; Arrobas, Ana; Marques, Maria L.; Lozoya, Carlos; Lopes, Cristina; Cardia, Francisca; Loureiro, Carla C.; Câmara, Raquel; Vieira, Inês; Silva, Sofia d.; Silva, Eurico; Rodrigues, Natalina; Fonseca, João A. 2021. "Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies" Int. J. Environ. Res. Public Health 18, no. 3: 1015. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031015

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