PT - JOURNAL ARTICLE AU - Cristina Longo AU - Lucie Blais AU - Marni Brownell AU - Jacqueline M. Quail AU - Mohsen Sadatsafavi AU - Amélie Forget AU - Marc-André Turcot AU - Yao Nie AU - Wenbin Li AU - Hamid Tavakoli AU - Qier Tan AU - Yuxin Fan AU - Robert W. Platt AU - Francine M. Ducharme TI - Association between asthma control trajectories in preschoolers and disease remission AID - 10.1183/13993003.01897-2020 DP - 2020 Jan 01 TA - European Respiratory Journal PG - 2001897 4099 - http://erj.ersjournals.com/content/early/2020/11/11/13993003.01897-2020.short 4100 - http://erj.ersjournals.com/content/early/2020/11/11/13993003.01897-2020.full AB - Introduction Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission.Methods We conducted a multicenter population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in 4 Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as ≥1 medical visit or medication for asthma every 6-month period for ≥4 of the 6 periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as two consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: controlled throughout, improving control, worsening control, out-of-control throughout, and fluctuating control. Adjusted Cox models estimated associations between asthma control trajectories and time-to-remission. A random-effects meta-analysis summarised province-specific Hazard Ratios (HRs).Results The pooled remission rate was 8.91 (95%CI 8.80,9.02)/100 person-years. Compared to children controlled throughout, poorer asthma control was associated with incrementally lower HRs (95%CI) of remission in 4 other trajectories: improving control, 0.89 (0.82,0.96); fluctuating control, 0.78 (0.71,0.85); worsening control, 0.68 (0.62,0.75); out-of-control throughout, 0.52 (0.45,0.59).Conclusions Asthma control trajectories 2 years following a diagnosis in preschool were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Ms. Borgese has nothing to disclose.Conflict of interest: Dr. Longo has nothing to disclose.Conflict of interest: Dr. Blais reports grants, personal fees and other from AstraZeneca, grants from TEVA, outside the submitted work.Conflict of interest: Dr. Brownell has nothing to disclose.Conflict of interest: Dr. Quail has nothing to disclose.Conflict of interest: Dr. Sadatsafavi has nothing to disclose.Conflict of interest: Dr. Forget has nothing to disclose.Conflict of interest: Dr. Turcot has nothing to disclose.Conflict of interest: Dr. Nie has nothing to disclose.Conflict of interest: Dr. LI has nothing to disclose.Conflict of interest: Dr. Tavakoli has nothing to disclose.Conflict of interest: Dr. Tan has nothing to disclose.Conflict of interest: Dr. Fan has nothing to disclose.Conflict of interest: Dr. Platt reports personal fees from Biogen, personal fees from Amgen, personal fees from Merck, personal fees from Abbvie, personal fees from Pfizer, personal fees from Elli Lilly, personal fees from Analysis Group, outside the submitted work.Conflict of interest: Dr. Ducharme reports grants and other from GlaxoSmithKline Canada, grants from MedTeq, grants and personal fees from Covis Pharma, grants and personal fees from Thorasys Inc., other from Novartis, other from Trudell Medical INternational, outside the submitted work.