Temporal asthma patterns using repeated questionnaires over 13 years in a large French cohort of women

PLoS One. 2013 May 31;8(5):e65090. doi: 10.1371/journal.pone.0065090. Print 2013.

Abstract

Variable expression is one aspect of the heterogeneity of asthma. We aimed to define a variable pattern, which is relevant in general health epidemiological cohorts. Our objectives were to assess whether: 1) asthma patterns defined using simple asthma questions through repeated measurements could reflect disease variability 2) these patterns may further be classified according to asthma severity/control. Among 70,428 French women, we used seven questionnaires (1992-2005) and a comprehensive reimbursement database (2004-2009) to define three reliable asthma patterns based on repeated positive answers to the ever asthma attack question: "never asthma" (n = 64,061); "inconsistent" ("yes" followed by "no", n = 3,514); "consistent" (fully consistent positive answers, n = 2,853). The "Inconsistent" pattern was related to both long-term (childhood-onset asthma with remission in adulthood) and short-term (reported asthma attack in the last 12 months, associated with asthma medication) asthma variability, showing that repeated questions are relevant markers of the variable expression of asthma. Furthermore, in this pattern, the number of positive responses (1992-2005) predicted asthma drug consumption in subsequent years, a marker of disease severity. The "Inconsistent" pattern is a phenotype that may capture the variable expression of asthma. Repeated answers, even to a simple question, are too often neglected.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy
  • Asthma / epidemiology*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Humans
  • Middle Aged
  • Risk Factors
  • Surveys and Questionnaires*

Substances

  • Anti-Asthmatic Agents

Grants and funding

The E3N study is supported by the Mutuelle Générale de l’Education Nationale (MGEN), the European Community, the French League against Cancer (LNCC), the Gustave Roussy Institute (IGR), the National Institute for Health and Medical Research (Inserm) and General Councils of France. The specific respiratory health survey in the E3N study was supported by the Fonds de dotation “Recherche en Santé Respiratoire”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.