Whispers of change in preschool asthma phenotypes: Findings in the French ELFE cohort

Rationale: Early life asthma phenotyping remains an unmet need in pediatric asthma. In France, severe pediatric asthma phenotyping has been done extensively; however, phenotypes in the general population remain under -explored. Based on the course and severity of respiratory/allergic symptoms, we aimed to identify and charac-terize early life wheeze profiles and asthma phenotypes in the general population. Methods: ELFE is a general population based birth cohort; which recruited 18,329 newborns in 2011, from 320 maternity units nationwide. Data was collected using parental responses to modified versions of ISAAC ques-tionnaire on eczema, rhinitis, food allergy, cough, wheezing, dyspnoea and sleep disturbance due to wheezing at 3 time points: post-natal (2 months), infancy (age 1) and pre-school (age 5). We built a supervised trajectory for wheeze profiles and an unsupervised approach was used for asthma phenotypes. Chi squared (chi 2) test or fisher's exact test was used as appropriate (p < 0.05). Results: Wheeze profiles and asthma phenotypes were ascertained at age 5. Supervised wheeze trajectory of 9161 children resulted in 4 wheeze profiles: Persistent (0.8%), Transient (12.1%), Incident wheezers at age 5 (13.3%) and Non wheezers (73.9%). While 9517 children in unsupervised clusters displayed 4 distinct asthma pheno-types: Mildly symptomatic (70%), Post-natal bronchiolitis with persistent rhinitis (10.2%), Severe early asthma (16.9%) and Early persistent atopy with late onset severe wheeze (2.9%). Conclusion: We successfully determined early life wheeze profiles and asthma phenotypes in the general popu-lation of France.

Automated summary

This study aimed to identify and characterize early life wheeze profiles and asthma phenotypes in the general population of France. By analyzing data from 18,329 newborns, four wheeze profiles and four asthma phenotypes were identified. This study is of great significance for the early identification and classification of pediatric asthma.