Project

Back to overview

Phenotypes and prognostic modelling in childhood asthma: moving towards clinical applications (Phase II)

English title Phenotypes and prognostic modelling in childhood asthma: moving towards clinical applications (Phase II)
Applicant Kühni Claudia
Number 182628
Funding scheme Project funding (Div. I-III)
Research institution Institut für Sozial- und Präventivmedizin Universität Bern
Institution of higher education University of Berne - BE
Main discipline Respiratory Diseases
Start/End 01.10.2018 - 30.09.2022
Approved amount 968'370.00
Show all

All Disciplines (2)

Discipline
Respiratory Diseases
Paediatrics

Keywords (7)

prognostic modelling; asthma; childhood; wheeze; cough; phenotype; prediction tool

Lay Summary (German)

Lead
Asthma ist die häufigste chronische Erkrankung im Kindesalter. Der Verlauf ist variabel, und kann schlecht vorausgesagt werden. Die vorliegende Studie benutzt detaillierte longitudinale Daten zu Kindern mit Asthma aus Schweizer Kinderkliniken und beschreibt die klinischen Erscheinungsbilder (Phänotypen) und deren Verlauf über die Zeit. Das Ziel ist, die Behandlung zu optimieren und die Kurz- und Langzeit-Prognose dieser Erkrankung besser vorauszusagen.
Lay summary

Inhalt und Ziel des Forschungsprojekts

Asthma ist eine entzündliche Erkrankung der Lunge, die oft bei Kinder vorkommt und zu chronischem Husten, pfeifender Atmung und Anfällen von Atemnot führt. Dies kann Spiel, Sport und  Lebensqualität der Kinder beeinträchtigen. Manche Kinder leiden nur kurzzeitig unter Asthma, bei anderen ist der Verlauf chronisch und kann sich über Jahre hinziehen. Bisherige Studien basierten vorwiegend auf Fragebogen, die an Familien mit Kindern verschickt wurden; Informationen aus ärztlichen Konsultationen wurden für die epidemiologische Forschung wenig benutzt.

Die vorliegende Studie rekrutiert alle Kinder, welche ambulant in Schweizer Kinderkliniken zur Diagnose und Behandlung von Asthma gesehen werden und verwertet die dort erfassten klinischen Daten. Der Verlauf wird durch wiederholte Fragebogen an die Eltern und eine App für Mobiltelefone über Jahre erfasst.  Dies ermöglicht, die Variabilität der Asthma Phänotypen bei Kindern genau zu beschreiben und die Faktoren zu erfassen, die den Schwergrade und den Langzeitverlauf bestimmen. 

 

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Dieses Projekt bietet eine einzigartige Möglichkeit, in einer nationalen Studie in der Schweiz die klinische Epidemiologie von häufigen Lungenproblemen bei Kindern zu erforschen. Langfristig erlaubt dies, die Behandlung der Patienten besser an ihren individuellen Phänotyp anzupassen und die präventiven Möglichkeiten zu optimieren.

Direct link to Lay Summary Last update: 16.11.2018

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
ERS International Congress 2020: highlights from the Paediatric Assembly
Ardura-Garcia Cristina, Cuevas-Ocaña Sara, Freitag Nadine, Kampouras Asterios, King John A., Kouis Panayiotis, Mensink-Bout Sara M., Whitehouse Abigail L., Williams Emma, Dassios Theodore, Duijts Liesbeth, Ersu Refika H, Gaillard Erol A., Horsley Alex R., Proesmans Marijke, Rottier Robbert, Schramm Dirk, Moeller Alexander, Pijnenburg Marielle W. (2021), ERS International Congress 2020: highlights from the Paediatric Assembly, in ERJ Open Research, 7, 00893-2020.
Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC)
Pedersen Eva S.L., de Jong Carmen C.M., Ardura-Garcia Cristina, Mallet Maria Christina, Barben Juerg, Casaulta Carmen, Hoyler Karin, Jochmann Anja, Moeller Alexander, Mueller-Suter Dominik, Regamey Nicolas, Singer Florian, Goutaki Myrofora, Kuehni Claudia E. (2021), Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC), in The Journal of Allergy and Clinical Immunology: In Practice, 9(2), 881-889.e3.
Agreement of parent‐ and child‐reported wheeze and its association with measurable asthma traits
Mozun Rebeca, Ardura-Garcia Cristina, Pedersen Eva S. L., Goutaki Myrofora, Usemann Jakob, Singer Florian, Latzin Philipp, Moeller Alexander, Kuehni Claudia E. (2021), Agreement of parent‐ and child‐reported wheeze and its association with measurable asthma traits, in Pediatric Pulmonology, 1-9.
Diagnosis in children with exercise‐induced respiratory symptoms: A multi‐center study
Pedersen Eva S. L., Ardura-Garcia Cristina, Jong Carmen C. M., Jochmann Anja, Moeller Alexander, Mueller-Suter Dominik, Regamey Nicolas, Singer Florian, Goutaki Myrofora, Kuehni Claudia E. (2021), Diagnosis in children with exercise‐induced respiratory symptoms: A multi‐center study, in Pediatric Pulmonology, 56(1), 217-225.
Treatment decisions in children with asthma in a real-life clinical setting: the Swiss Paediatric Airway Cohort (SPAC)
Ardura-Garcia Cristina, Pedersen Eva SL., Mallet Maria Christina, Jong Carmen CM. de, Barben Juerg, Jochmann Anja, Jung Andreas, Mueller-Suter Dominik, Regamey Nicolas, Singer Florian, Kuehni Claudia E. (2021), Treatment decisions in children with asthma in a real-life clinical setting: the Swiss Paediatric Airway Cohort (SPAC), in The Journal of Allergy and Clinical Immunology: In Practice.
Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort
de Jong Carmen CM., Pedersen Eva SL., Mozun Rebeca, Müller-Suter Dominik, Jochmann Anja, Singer Florian, Casaulta Carmen, Regamey Nicolas, Moeller Alexander, Ardura-Garcia Cristina, Kuehni Claudia E (2020), Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort, in European Respiratory Journal, 2000132-2000132.
Paediatric cohort studies on lower respiratory diseases and their reporting quality: systematic review of the year 2018
Ardura-Garcia Cristina, Mozun Rebeca, Pedersen Eva S.L., Otth Maria, Mallet Maria Christina, Goutaki Myrofora, Kuehni Claudia E. (2020), Paediatric cohort studies on lower respiratory diseases and their reporting quality: systematic review of the year 2018, in European Respiratory Journal, 2000168-2000168.
Cigarette, shisha, and electronic smoking and respiratory symptoms in Swiss children: The LUIS study
Mozun Rebeca, Ardura-Garcia Cristina, Jong Carmen C. M., Goutaki Myrofora, Usemann Jakob, Singer Florian, Latzin Philipp, Kuehni Claudia E., Moeller Alexander (2020), Cigarette, shisha, and electronic smoking and respiratory symptoms in Swiss children: The LUIS study, in Pediatric Pulmonology, 55, 2806-2815.
Diagnosis of asthma in children: the contribution of a detailed history and test results
de Jong Carmen C.M., Pedersen Eva S.L., Mozun Rebeca, Goutaki Myrofora, Trachsel Daniel, Barben Juerg, Kuehni Claudia E. (2019), Diagnosis of asthma in children: the contribution of a detailed history and test results, in European Respiratory Journal, 54(6), 1901326-1901326.
Does high-flow oxygen reduce escalation of care in infants with hypoxaemic bronchiolitis?
Mozun Rebeca, Pedersen Eva S.L., Ardura-Garcia Cristina (2019), Does high-flow oxygen reduce escalation of care in infants with hypoxaemic bronchiolitis?, in Breathe, 15(3), 247-249.
Addressing selection bias in diagnostic accuracy studies
Pedersen Eva SL, de Jong Carmen CM (2019), Addressing selection bias in diagnostic accuracy studies, in Pediatrics International, 61(8), 840-840.
Reducing childhood respiratory morbidity and mortality in low and middle income countries: a current challenge
Ardura-Garcia Cristina, Kuehni Claudia E. (2019), Reducing childhood respiratory morbidity and mortality in low and middle income countries: a current challenge, in European Respiratory Journal, 54(1), 1900987-1900987.
Do clinical investigations predict long‐term wheeze? A follow‐up of pediatric respiratory outpatients
Jong Carmen C. M., Pedersen Eva SL., Goutaki Myrofora, Trachsel Daniel, Barben Juerg, Kuehni Claudia E. (2019), Do clinical investigations predict long‐term wheeze? A follow‐up of pediatric respiratory outpatients, in Pediatric Pulmonology, ppul.24347-ppul.24347.
The Simple 10-Item Predicting Asthma Risk in Children Tool to Predict Childhood Asthma—An External Validation
Pedersen Eva S.L., Spycher Ben D., de Jong Carmen C.M., Halbeisen Florian, Ramette Alban, Gaillard Erol A., Granell Raquel, Henderson A. John, Kuehni Claudia E. (2019), The Simple 10-Item Predicting Asthma Risk in Children Tool to Predict Childhood Asthma—An External Validation, in The Journal of Allergy and Clinical Immunology: In Practice, 7(3), 943-953.e4.
The Swiss Paediatric Airway Cohort (SPAC)
Pedersen Eva S.L., de Jong Carmen C.M., Ardura-Garcia Cristina, Barben Juerg, Casaulta Carmen, Frey Urs, Jochmann Anja, Latzin Philipp, Moeller Alexander, Regamey Nicolas, Singer Florian, Spycher Ben, Sutter Oliver, Goutaki Myrofora, Kuehni Claudia E. (2018), The Swiss Paediatric Airway Cohort (SPAC), in ERJ Open Research, 4(4), 00050-2018-00050-2018.
Protective effects of breastfeeding on respiratory symptoms in infants with 17q21 asthma risk variants
Gorlanova O., Illi S., Toncheva A. A., Usemann J., Latzin P., Kabesch M., Dalphin J.-C., Lauener R., Pekkanen J. R., Von Mutius E., Riedler J., Kuehni C. E., Röösli M., Frey U. (2018), Protective effects of breastfeeding on respiratory symptoms in infants with 17q21 asthma risk variants, in Allergy, 73(12), 2388-2392.

Collaboration

Group / person Country
Types of collaboration
University Children's Hospital Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Children's hospital St. Gallen Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Children's Hospital Chur Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
University Children's Hospital, Basel, UKBB Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Paediatric practice, Worb Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Paediatric pulmonology practice, Horgen Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
University Children's Hospital Zurich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Children's Hospital Aarau Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Children's Hospital Lucerne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Children's Hospital Bern, Insel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
European Respiratory Society Annual Conference 2020 Poster Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort 06.09.2020 Vienna, Austria Kühni Claudia; Ardura Garcia Cristina; Pedersen Eva Sophie Lunde;
European Respiratory Society Annual Conference 2020 Poster Parent-child agreement in reporting of current wheeze: can we trust questionnaires? 06.09.2020 Vienna, Austria Kühni Claudia; Ardura Garcia Cristina; Pedersen Eva Sophie Lunde;
European Respiratory Society Annual Conference 2020 Poster Asthma treatment for children in tertiary care in Switzerland 06.09.2020 Vienna, Austria Ardura Garcia Cristina; Mallet Christina; Kühni Claudia; Pedersen Eva Sophie Lunde;
Clinical data for paediatric research: the Swiss approach, 2019 Talk given at a conference SPAC: the Swiss Paediatric Airway Cohort: patient-reported and health recorded data from respiratory outpatient clinics in Switzerland 05.12.2019 Bern, Switzerland Kühni Claudia;
European Respiratory Society Annual Conference 2019 Poster Diagnosing asthma accurately in school-aged children suspected to have asthma 28.09.2019 Madrid, Spain Ardura Garcia Cristina; Kühni Claudia; Pedersen Eva Sophie Lunde;
European Respiratory Society Annual Conference 2019 Poster Does asthma treatment still vary by sex in Switzerland? 28.09.2019 Madrid, Spain Ardura Garcia Cristina; Kühni Claudia;
European Respiratory Society Annual Conference 2019 Poster Asthma control in children seen in Swiss outpatient clinics 28.09.2019 Madrid, Spain Kühni Claudia; Ardura Garcia Cristina; Pedersen Eva Sophie Lunde;
European Respiratory Society Annual Conference 2019 Poster Diagnosing children with exercise induced respiratory symptoms - the Swiss Paediatric Airway Cohort 28.09.2019 Madrid, Spain Ardura Garcia Cristina; Kühni Claudia; Pedersen Eva Sophie Lunde;
Swiss Public Health Conference, 2019 Talk given at a conference Smoking behaviour in Swiss schoolchildren, a public health outstanding issue 28.08.2019 Winterthur, Switzerland Ardura Garcia Cristina; Kühni Claudia;
Swiss Public Health Conference, 2019 Talk given at a conference Diagnosing asthma accurately in school-aged children suspected to have asthma 28.08.2019 Winterthur, Switzerland Pedersen Eva Sophie Lunde; Kühni Claudia;
Swiss Public Health Conference, 2019 Talk given at a conference Diagnosis in children with exercise induced respiratory symptoms - findings form the Swiss Paediatric Airway Cohort 28.08.2019 Winterthur, Switzerland Ardura Garcia Cristina; Kühni Claudia; Pedersen Eva Sophie Lunde;
Jahresversammlung der Schweizerischen Gesellschaft für Pädiatrie SGP, 2019 Talk given at a conference Diagnosing asthma accurately in school-aged children suspected to have asthma 06.06.2019 Bellinzona, Switzerland Kühni Claudia; Pedersen Eva Sophie Lunde;
Jahresversammlung der Schweizerischen Gesellschaft für Pädiatrie SGP, 2019 Talk given at a conference Asthma control in children referred to Swiss outpatient clinics 06.06.2019 Bellinzona, Switzerland Ardura Garcia Cristina; Kühni Claudia; Pedersen Eva Sophie Lunde;
Jahresversammlung der Schweizerischen Gesellschaft für Pädiatrie SGP, 2019 Talk given at a conference Are there still sex-specific differences in asthma symptoms and treatment in Swiss school-aged children 06.06.2019 Bellinzona, Switzerland Kühni Claudia; Ardura Garcia Cristina;


Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) Swiss Paediatric Airway Cohort (SPAC) homepage Webpage International 2018

Awards

Title Year
Best oral presentation of the SwissPedNet translational & clinical research session at Swiss Society of Paediatrics (SGP) annual congress in Bellinzona 2019

Associated projects

Number Title Start Funding scheme
192804 Natural history, phenotypes and disease classification in primary ciliary dyskinesia (phase 2) 01.05.2020 Project funding (Div. I-III)
162820 Phenotypes and prognostic modelling in childhood asthma: moving towards clinical applications 01.10.2015 Project funding (Div. I-III)

Abstract

This proposal builds on our previous work on phenotypes and prognostic modelling in childhood asthma, but shifts focus from population-based to clinical datasets. The Swiss Paediatric Asthma Cohort (SPAC) is a collaborative project of paediatric teaching hospitals with close links to a Swiss Personalized Health Network (SPHN) infrastructure development project. Data from hospital records are combined with data reported by patients via questionnaires and mobile phones to understand the factors determining short-term and long-term prognosis of asthma and related disorders in childhood. Background: Asthma is the most common chronic disease in children. Diagnosing asthma in early childhood is difficult and considerably more children affected by asthma-related symptoms than are given a diagnosis. Although recent research on phenotypes of wheeze and cough has shed new light on the heterogeneity of childhood asthma, it remains unclear how phenotypes evolve as children grow older. Both the exacerbations of asthma in the short term and its remission or persistence in the long term are still poorly understood. Using population based cohort studies, several groups including ours have developed prognostic models to aid physicians in the long-term prediction of children's risk for asthma. However, the performance of these models is only moderate and their utility in clinical practice has not been tested. How routine diagnostic tests such as spirometry, allergy tests, exhaled nitric oxide, and bronchial challenges contribute to predicting disease course remains particularly unclear. Objectives: The project will use data from several birth cohorts and a large clinical cohort study to1.Explore the variability of asthma phenotypes over time and with age.2.Improve prediction tools for long-term outcomes of childhood asthma.3.Identify determinants of short-term disease course and asthma control.Methods: We will analyse data from population-based cohort studies, namely the Leicester Respiratory Cohorts (LRC; in 1990, N=1,650 and in 1998, N=8,700), the Bern-Basel Infant Lung Development (BILD) cohort (N=837), and the Avon Longitudinal Study of Parents and Children (ALSPAC, N=7,000) and data from a clinical cohort, the Swiss Paediatric Airway Cohort. SPAC includes children referred to respiratory outpatient clinics of tertiary care paediatric hospitals in Switzerland for evaluation of wheeze, chronic cough, and exercise- or sleep-related respiratory symptoms. In March 2108, SPAC included 347 patients. Increasing recruitment rates (currently 70-80 per month) will result in an estimated 1000 participants by Dec 2018 and 3400 by Dec 2020. Baseline data include extended questionnaires plus results of all investigations done in the clinic. Measurements are being standardised nationally in an ongoing SPHN project to harmonize paediatric datasets across Swiss hospitals. Outcomes will be assessed via annual questionnaires for parents and, beginning 2019, monthly diaries collected through an interactive web application. We will analyse the data using state-of the art statistical modelling approaches including latent transition analyses to model trajectories of change in phenotypes as children grow older and penalized logistic regression to develop prognostic models. EQUATOR guidelines will be followed in the external validation and reporting of results.Output and significance: The project uniquely combines the strengths of population-based and clinical studies to better understand phenotypic variability and disease course of childhood asthma and be directly relevant to patient care. It will establish and exploit a nationwide, longitudinal dataset combining standardised data from clinics, parents, routine diagnostic testing, and regular follow-up. The project outcomes will include clinical prediction tools to assist to assist forecasting asthma exacerbations and emergency consultations, and long-term risks of disease persistence. Together with improved characterisation of clinical phenotypes, this will facilitate optimising treatment of high-risk children while at the same time reducing overtreatment of those at low risk.
-