Asthma and lower airway diseaseNovel severe wheezy young children phenotypes: Boys atopic multiple-trigger and girls nonatopic uncontrolled wheeze
Section snippets
Methods
Patients were part of the 3-year (2008-2010) Trousseau Asthma Program of the Centre de l'Asthme et des Allergies at the Hôpital Trousseau in Paris; the study included children with recurrent wheezing. All the children had been referred to the center by a primary care physician for persistent, recurrent wheezing; 67% were outpatients from Paris and the surrounding area, and the remaining 33% were from all regions of France. Data were collected from the children by using questionnaires and
Description of the population
We studied 551 consecutive pediatric outpatients with recurrent wheezing. There were 384 boys (69.7%), and the average age of participants was 19 ± 8.8 months. Most children had uncontrolled or partially controlled wheezing and were receiving ICS (51% were receiving high doses and 29% were receiving low doses).
Asthma phenotypes, based on cluster analysis
We used the cluster approach to generate a dendrogram that revealed 3 clusters of children with shared phenotypes (see Fig E1 in this article's Online Repository at www.jacionline.org).
Discussion
We identified 2 novel phenotypes of severe wheezing, which we called atopic MTW and nonatopic uncontrolled wheeze, compared with a phenotype of milder, recurrent wheeze, which we called mild EVW.
Previously reported phenotypes of wheezing preschool children, but not infants, were classified as EVW and MTW, based on expert recommendations for treatment.4 Sonnappa et al17 associated MTW with significant abnormalities in pulmonary function, independent of atopy or wheezing status. Our analysis of
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Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.