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Wednesday, May 18, 2022

More evidence links asthma severity with age of onset

The recently published multinational cohort study may be the largest to date, finding that asthma onset is an integral factor in defining disease severity and frequency of comorbidities.

“It’s very easy to ask your patient, ‘Did you have asthma in childhood? When did your asthma start?'” explained co-author Guy Brussel, MD, a professor at the University of Ghent in Belgium. Medscape Medical News in an interview. “You don’t need expensive investigations, [computed tomography] (CT) scan or proteomics or genomics; Just two simple questions. ,

Retrospective Cohort Study, Published in Journal of Allergy and Clinical Immunology: In Practice, a joint national electronic health record database from five different countries—the United Kingdom, Spain, Italy, the Netherlands and Denmark—which included 586,436 adult asthma patients. The study divided patients into three subtypes: childhood-onset asthma, meaning diagnosed before the age of 18 (n = 81,691); adult-onset disease, defined as diagnosed between the ages of 18 and 40 (n = 218,184); and late onset, defined as a diagnosis made after the age of 40 (n = 286,561).

Brussel said the study found substantial differences in characteristics between the three subtypes, including an increased risk for women with later age. In the five databases, women comprised about 45% of those with childhood-onset asthma, but about 60% with later-onset disease, Brussel said.

For asthma characteristics, 7.2% (n = 42,611) of the cohort had severe asthma, but the proportion was highest in late-onset asthma, 10% versus 5% adult-onset and 3% childhood-onset. The percentage of uncontrolled asthma followed a similar trend: 8%, 6% and 0.4% in the respective treatment groups.

The most common comorbidities were atopic disorder (31%) and overweight/obesity (50%). The prevalence of atopic disorders was highest in the childhood-onset group, 45% versus 35%, and 25% in adult-onset and late-onset patients. However, the overweight/obesity trend reversed: 30%, 43% and 61%, respectively.

“The big differences were when comparing late-onset asthma to adult-onset asthma with respect to comorbidities,” Brussel said. “Patients with late-onset asthma often had nasal polyposis.” These patients usually lose their ability to smell, Brussel said, as is the case with COVID-19. However, in nasal polyposis the damage is chronic rather than transient.

Brussel said pulmonologists should be concerned with the prevalence of overweight/obesity in the late-onset group. “We know that obesity is an important risk factor for diabetes, and then obesity is also associated with gastroesophageal reflux—and we know that gastroesophageal reflux is a risk factor for asthma exacerbations.”

Brussel said smaller studies have reached the same conclusion regarding the relationship between asthma severity and age of onset. What is remarkable about this study is its size and consistency of findings across various national databases, he said.

“In early childhood you need to look for different allergies—atopic dermatitis and allergic rhinitis—but in late-onset asthma look for obesity, diabetes and reflux disease, and nasal polyposis,” he says. said.

Sally E. Wenzel, MD, professor at the University of Pittsburgh School of Public Health and director of the Institute for Asthma and Environmental Lung Health at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, both agreed that the size of this study makes it worth mentioning.

“This is certainly by far and away the largest study of its kind to date, and it is multinational,” she said. medscape, “Just doing a study like this with thousands and thousands of patients is a step in the right direction. Perhaps that’s what’s so unique about it, to bring all these clinical collaborators together and see what’s the relation to age of onset.

She also noted that this study is unique in how it groups groups by age of onset.

“In addition to the concept that there is a difference in the age at which you are diagnosed with asthma, I think it is also important to remember that when a physician, whether they are a specialist or a non-specialist, sees a patient with asthma. “They should ask them when their symptoms developed,” she said. “These are really simple questions that take no sophisticated training and no sophisticated equipment to measure, but they can be really helpful. “

GlaxoSmithKline supplied a grant for the study. Brussels disclosed ties with AstraZeneca, Boehringer Ingelheim, Chisie, GSK, Novartis, Sanofi and Teva. One study co-author is an employee of GSK. Wenzel did not report any disclosures.

The Journal of Allergy and Clinical Immunology: In Practice, Published online April 7, 2022. Summary.

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