The All Age Asthma Cohort (ALLIANCE)

From Early Beginnings to Chronic Disease: A Longitudinal Cohort Study

Oliver Fuchs; Thomas Bahmer; Markus Weckmann; Anna-Maria Dittrich; Bianca Schaub; Barbara Rösler; Christine Happle; Folke Brinkmann; Isabell Ricklefs; Inke R. König; Henrik Watz; Klaus F. Rabe; Matthias V. Kopp; Gesine Hansen; Erika von Mutius

Disclosures

BMC Pulm Med. 2018;18(140) 

In This Article

Background

Wheezing disorders and asthma are the most prevalent chronic respiratory diseases both in childhood and adulthood. About 25–30% of children have at least one episode of wheeze before their 3rd birthday, but considerable clinical heterogeneity exists.[1,2] Many of these children become symptom-free between 3 and 8 years of age, but some go on to persistent asthma in later childhood and adulthood.[3]

Although the characteristic clinical manifestations of asthma in children and in adults are rather uniform with wheezing, shortness of breath and cough, population-based clinical and genetic studies suggest that asthma is not one disease but many.[4] Despite its prevalence, little is known about the diverse underlying pathomechanisms determining the different asthma phenotypes both in children and adults, including asthma transition (Figure 1).[3–6] Affected individuals vary with regard to severity and nature of their primary complaints, but also in relation to comorbidities, response to treatment, and to the course of the disease throughout life.[2] The different asthma phenotypes and trajectories are presumably caused by diverse underlying pathophysiological processes. Recent related research also takes complex, explicit molecular data into account to better link biology to clinical presentation which may then be called an asthma endotype.[5,7]

Figure 1.

Wheeze and asthma phenotypes during childhood and adulthood. About 25–30% of children have at least one episode of wheeze before their 3rd birthday, but considerable clinical heterogeneity exists (broken line box I). Children with transient wheeze become symptom-free before school-age, those with non-atopic asthma after about 8 years of age. However, some, especially those with persistent atopic wheeze and seasonal triggers of wheeze go on to persistent asthma in later childhood and adulthood. Interestingly, girls present with new-onset asthma in significant numbers during adolescence, thereby adding to turning the sex-based bias from male towards female sex. While there is also new-onset-asthma during adulthood, it is unclear whether differences between persistent childhood asthma phenotypes continue throughout transition (broken line box II) into adulthood

So far, most (endo)-phenotyping has been applied in children and adults separately. Consequently, there is a substantial intrinsic bias towards more pathophysiological data from cross-sectional studies in adults and more epidemiological data for children, respectively.[3] However, common predictors and subsequent targeted treatment - or even prevention strategies - are urgently needed, especially early in life. Asthma research to date should therefore integrate standardized molecular approaches in identical ways in longitudinal studies in paediatric and adult populations.[3,8,9] The decoding of mechanisms underlying the asthma syndrome, and their translation to the individual patient across all ages is the overall aim of the All Age Asthma Cohort (ALLIANCE) of the German Centre for Lung Research (Deutsches Zentrum für Lungenforschung, DZL).

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