Asthma as an outcome: Exploring multiple definitions across birth cohorts in the children's respiratory and environmental workgroup
Visness C, Gebretsadik T, Jackson DJ, Gern JE, Biagini Myers J, Havstad S, Lemanske RF, Hartert TV, Khurana Hershey GK, Zoratti EM, Martin L, and Johnson CC. Asthma as an outcome: Exploring multiple definitions across birth cohorts in the children's respiratory and environmental workgroup. Am J Respir Crit Care Med 2018; 197:A4594.
Am J Respir Crit Care Med
Rationale: A 2010 review of asthma birth cohort studies found 60 different definitions for the outcome of asthma among 122 studies. Reports regarding the risk of developing asthma may be sensitive to the outcome definition, which can result in inconsistent findings across birth cohorts. Methods: We use data from 5 longitudinal US birth cohorts that are part of the Children's Respiratory and Environmental Workgroup (CREW) consortium within the ECHO program to examine how the prevalence of asthma in middle childhood (age 6-10 years) varies by applying individual cohort outcome definitions across the other cohorts, where possible. Two cohorts (Wayne County Health Environment Allergy and Asthma Longitudinal Study [WHEALS], Childhood Allergy/Asthma Study [CAS]) were recruited from the general population and determined asthma status by parental report of physician diagnosis. The other three cohorts (Childhood Origins of Asthma Study [COAST], Urban Environment and Childhood Asthma [URECA], Cincinnati Childhood Allergy and Air Pollution Study [CCAAPS]) recruited children with an elevated risk for developing asthma based on a family history in at least one parent. CCAAPS verified asthma status using bronchodilator reversibility and methacholine challenge. COAST and URECA used a combination of reported diagnosis, symptoms, and medication use to determine asthma status, but followed different algorithms. Results: Asthma prevalence using the original cohort definitions ranged from 10 to 28%, and was strongly influenced by whether the cohort population was selected to be at high risk for asthma development or not (23% vs. 16%, p