Episodic viral wheeze and multiple‐trigger wheeze in preschool children are neither distinct nor constant patterns. A prospective multicenter cohort study in secondary care
Grants: The study was funded by Stichting Astma Bestrijding. Contact information: Meibergdreef 15 K2‐117, 1105 AZ Amsterdam. Email: A.deGraaf@amc.uva.nl
Results
Of 660 3‐month periods, the diary‐based phenotype was EVW in 11%, MTW in 54% and 35% were free from respiratory episodes. Pediatrician‐based classification showed 59% EVW and 26% MTW. The Kappa measure of agreement between diary‐based and pediatrician‐assigned phenotypes was very low (0.12, 95%CI, 0.07‐0.17). Phenotypic instability was observed in 32% of cases. PCR was positive in 71% during URTI symptoms, 66% during respiratory symptoms and 38% in the absence of symptoms.
Conclusion
This study shows that EVW and MTW are variable over time within patients. Pediatrician classification of these phenotypes based on clinical history does not correspond to prospectively recorded symptom patterns. The applicability of these phenotypes as a basis for therapeutic decisions and prognosis should be questioned.
No comments:
Post a Comment