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Overcoming heterogeneity in pediatric asthma: tobacco smoke and asthma characteristics within phenotypic clusters in an African American cohort.

AbstractOBJECTIVE:
Asthma in children and adolescents is a heterogeneous syndrome comprised of multiple subgroups with variable disease expression and response to environmental exposures. The goal of this study was to define homogeneous phenotypic clusters within a cohort of children and adolescents with asthma and to determine overall and within-cluster associations between environmental tobacco smoke (ETS) exposure and asthma characteristics.
METHODS:
A combined hierarchical/k-means cluster analysis of principal component variables was used to define phenotypic clusters within a cohort of 6- to 20-year-old urban and largely minority subjects.
RESULTS:
Among the 154 subjects, phenotypic cluster analysis defined three independent clusters (Cluster 1 [n = 57]; Cluster 2 [n = 33]; Cluster 3 [n = 58]). A small fourth cluster (n = 6) was excluded. Patients in Cluster 1 were predominantly males, with a relative abundance of neutrophils in their nasal washes. Patients in Cluster 2 were predominantly females with high body mass index percentiles and later-onset asthma. Patients in Cluster 3 had higher eosinophil counts in their nasal washes and lower Asthma Control Test (ACT) scores. Within-cluster regression analysis revealed several significant associations between ETS exposure and phenotypic characteristics that were not present in the overall cohort. ETS exposure was associated with a significant increase in nasal wash neutrophils (beta coefficient = 0.73 [95% confidence interval, CI: 0.11 to 1.35]; p = .023) and a significant decrease in ACT score (-5.17 [-8.42 to -1.93]; p = .003) within Cluster 1 and a significant reduction in the bronchodilator-induced % change in forced expiratory volume in one second (FEV(1)) (-36.32 [-62.18 to -10.46]; p = .009) within Cluster 3.
CONCLUSIONS:
Clustering techniques defined more homogeneous subgroups, allowing for the detection of otherwise undetectable associations between environmental tobacco smoke exposure and asthma characteristics.
AuthorsAngela S Benton, Zuyi Wang, Jennifer Lerner, Matthew Foerster, Stephen J Teach, Robert J Freishtat
JournalThe Journal of asthma : official journal of the Association for the Care of Asthma (J Asthma) Vol. 47 Issue 7 Pg. 728-34 (Sep 2010) ISSN: 1532-4303 [Electronic] England
PMID20684733 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Tobacco Smoke Pollution
Topics
  • Adolescent
  • Adult
  • African Americans
  • Asthma (ethnology, etiology)
  • Child
  • Cluster Analysis
  • Cohort Studies
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Phenotype
  • Principal Component Analysis
  • Tobacco Smoke Pollution (adverse effects)

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