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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Allergy+Clin+Immunol
2014 ; 133
(5
): 1289-300, 1300.e1-12
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Classification of childhood asthma phenotypes and long-term clinical responses to
inhaled anti-inflammatory medications
#MMPMID24892144
Howrylak JA
; Fuhlbrigge AL
; Strunk RC
; Zeiger RS
; Weiss ST
; Raby BA
J Allergy Clin Immunol
2014[May]; 133
(5
): 1289-300, 1300.e1-12
PMID24892144
show ga
BACKGROUND: Although recent studies have identified the presence of phenotypic
clusters in asthmatic patients, the clinical significance and temporal stability
of these clusters have not been explored. OBJECTIVE: Our aim was to examine the
clinical relevance and temporal stability of phenotypic clusters in children with
asthma. METHODS: We applied spectral clustering to clinical data from 1041
children with asthma participating in the Childhood Asthma Management Program.
Posttreatment randomization follow-up data collected over 48 months were used to
determine the effect of these clusters on pulmonary function and treatment
response to inhaled anti-inflammatory medication. RESULTS: We found 5
reproducible patient clusters that could be differentiated on the basis of 3
groups of features: atopic burden, degree of airway obstruction, and history of
exacerbation. Cluster grouping predicted long-term asthma control, as measured by
the need for oral prednisone (P < .0001) or additional controller medications (P
= .001), as well as longitudinal differences in pulmonary function (P < .0001).
We also found that the 2 clusters with the highest rates of exacerbation had
different responses to inhaled corticosteroids when compared with the other
clusters. One cluster demonstrated a positive response to both budesonide (P =
.02) and nedocromil (P = .01) compared with placebo, whereas the other cluster
demonstrated minimal responses to both budesonide (P = .12) and nedocromil (P =
.56) compared with placebo. CONCLUSION: Phenotypic clustering can be used to
identify longitudinally consistent and clinically relevant patient subgroups,
with implications for targeted therapeutic strategies and clinical trials design.