Phenotype definition in childhood asthma: a novel, multidimensional approach to characterise asthma phenotypes in south Asian and white children

Summary

To understand how many different types of asthma there are, the role of genes & environmental factors in making children wheeze.

Study description

Asthma varies from one person to another in all sorts of ways. Some people find that their asthma is much more variable than others, and the type and severity of symptoms can differ. The age of onset of asthma is not always the same and some people find that their asthma disappears, although for some it may come back later in life. The variability of asthma is also obvious from measurements of lung function and responses to different forms of treatment.

The factors that contribute to this variability of asthma may include genetic differences, early exposure to allergens, infection, pollution, and other environmental factors.

This project will study large numbers of children who have been involved in our ongoing research. We already have a lot of information about them and we will now carry out detailed measurements of their lung function and allergic tendencies.

We will apply powerful statistical analysis techniques to identify different types of asthma, called ‘phenotypes’, which are groups of individuals with common features. We will then be able to explore the risk factors (genetics, environmental exposures) associated with each phenotype. This will ultimately help to find out what is important for improving the health of children with asthma in a way which is tailored specifically to the individual phenotype of this child.

Current status

During the past 3 years, we get permission and support of Education Authorities and the school head teachers. We visited 55 out of a possible total of 67 schools in both the County and City of Leicester. In total 979 young people participated. They filled in questionnaires and performed lab measurements including skin prick tests, pre- and post-bronchodilator spirometry. Exhaled NO, blood pressure, buccal smears, weight and height were also collected. New publications are in preparation.

Publications

Spycher BD, Silverman M, Pescatore AM, Beardsmore CS, Kuehni CE. 
Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts.
J Allergy Clin Immunol. 2013 Nov; 132(5):1058-67/ doi: 10.1016/j.jaci.2013.08.002.

Strippoli MPF, Spycher BD, Pescatore AM, Beardsmore CS, Silverman M, Kuehni CE. 
Viral wheezing is virus-specific - not only host-specific (authors's reply). 
Eur Respir J. 2012 Jan;39(1):228-9; author reply 229. doi: 10.1183/09031936.00150811.

Strippoli MPF, Spycher BD, Pescatore AM, Beardsmore CS, Silverman M, Kuehni CE.
Exclusive viral wheeze and allergic wheeze: evidence for discrete phenotypes. 
Eur Respir J 2011;38:472-474

Spycher BD, Silverman M, Kuehni CE.
Phenotypes of childhood asthma: are they real?
Clin Exp Allergy 2010;40:1130-1141

Spycher BD, Silverman M, Barben J, Eber E, Guinand S, Levy ML, Pao C, van Aalderen WM, von Schayck OCP, Kuehni CE.
A disease model for wheezing disorders in preschool children based on clinicians' perceptions.
Plos One 2009;4(12):e8533

Spycher BD, Minder CE, Kuehni CE.
Multivariate modelling of responses to conditional items: New possibilities for latent class analysis.
Stat Med 2009;28:1927-1939

Spycher BD, Silverman M, Brooke AM, Zwahlen M, Kuehni CE.
Distinguishing phenotypes of childhood wheeze and cough: a novel approach with prognosis relevance.
Eur Respir J 2008;31:974-981

Conference abstracts

Spycher BD, Sterne JAC, Granell R, Silverman M, Pescatore AM, Gaillard E, Henderson J, Kuehni CE. 
Multiple trigger and episodic viral wheeze in early childhood: are these phenotypes stable over time?  
European Respiratory Society annual congress, Vienna, 2012.

Strippoli MPF, Hallberg A, Beardsmore CS, Silverman M, Grigg J, Kuehni CE.
Early life exposure to locally-generated PM10 and lung function measurements at school-age.
European Respiratory Society annual congress, Amsterdam, 2011.

Spycher BD, Silverman M, Strippoli MPF, Kuehni CE.
Phenotypes of childhood wheeze and cough: can they be identified from epidemiological data?
European Respiratory Society annual congress, Barcelona, 2010.

Strippoli MPF, Kuehni CE, Spycher BD, McNally T, Silverman M, Beardsmore CS. 
Does the difference in lung function between UK-born south Asian and white children diminish in subsequent generations of immigrants? 
European Respiratory Society annual congress, Barcelona, 2010.

Strippoli MPF, Leonardi NA, Spycher BD, Beardsmore CS, Silverman M, Kuehni CE. 
Triggers of wheeze in 1-9 year old children: evidence for independent mechanisms? 
European Respiratory Society annual congress, Barcelona, 2010.

Spycher BD, Silverman M, Strippoli MPF, Kuehni CE.
Childhood wheeze: one or several diseases?
European Respiratory Society annual congress, Vienna, 2009.

Kuehni CE, Silverman M, Strippoli MPF, Brook AM, Spycher BD. 
Non-specific chronic cough in children: a novel method for identification of clinical phenotypes. 
European Respiratory Society annual congress, Stockholm, 2007.

Strippoli MPF, Sliverman M, Spycher BD, Brooke AM, Kuehni CE. 
Physiological characteristics of viral compared to multiple trigger wheezers. 
Swiss Society of Paediatrics annual congress, Zurich, 2007.

Spycher BD, Silverman M, Minder CE, Kuehni CE. 
Phenotype definition in preschool wheezing illness: a data-driven approach. 
European Respiratory Society annual congress, Munich, 2006.