Predictors for the development of progressive severity in new-onset adult asthma

• Published in: Journal of allergy and clinical immunology Vol. 134; no. 5; pp. 1051 - 1056.e2
• Main Authors: Westerhof, Guus A., MD, Vollema, Elise M., MD, Weersink, Els J., MD, PhD, Reinartz, Susanne M., MD, PhD, de Nijs, Selma B., PhD, Bel, Elisabeth H., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2014; Elsevier; Elsevier Limited
• Subjects: Adult; Adult-onset asthma; Allergy and Immunology; Asthma; Asthma - pathology; Asthma - physiopathology; asthma severity; Biological and medical sciences; Body mass index; Chronic obstructive pulmonary disease, asthma; Disease; Disease Progression; Drug therapy; Female; Follow-Up Studies; Forced Expiratory Volume; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Genotype & phenotype; Hospitals; Humans; Immunopathology; Laboratories; Male; Medical sciences; Middle Aged; new-onset asthma; Pneumology; predictors; prospective follow-up study; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; smoking; Smoking - adverse effects; Surveys and Questionnaires; predictors; OR; Forced vital capacity; new-onset asthma; asthma severity; prospective follow-up study; ACQ; Asthma Control Questionnaire; FVC; GINA; Global Initiative for Asthma; smoking; AMC; Odds ratio; Chronic obstructive pulmonary disease; Adult-onset asthma; Academic Medical Centre; COPD; Human; Lung disease; Immunopathology; Respiratory disease; Prediction; Tobacco smoking; Early stage; Asthma; Prospective; Immunology; Age of onset; Follow up study; Bronchus disease; Adult; Obstructive pulmonary disease; Predictive factor
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2014.05.005

Background A proportion of patients with adult-onset asthma have severe disease. Risk factors for an increase in asthma severity are poorly known. Objective We sought to identify predictors for the development of severe asthma in adults. Methods A cohort of 200 adults with new-onset asthma was prospectively followed for 2 years. At baseline, patients underwent a comprehensive assessment of clinical, functional, and inflammatory parameters. After 2 years, change in asthma severity was assessed by using the Global Initiative for Asthma score (range, 1-4), which is based on asthma control (Asthma Control Questionnaire), lung function (FEV1 ), and inhaled corticosteroid requirement. ANOVA and multiple regression equations were used in the analysis. Results One hundred twenty-eight patients completed 2 years of follow-up. Seventeen (13.3%) patients had an increase in asthma severity, whereas 53 (41.4%) patients had a decrease. A lower postbronchodilator FEV1 /forced vital capacity ratio and a higher number of cigarette pack years smoked at baseline were significantly associated with an increase in asthma severity at follow-up. Multiple regression equations showed that only the number of cigarette pack years smoked was independently associated with an increase in asthma severity, with an odds ratio of 1.4 (95% CI, 1.02-1.91) for every 10 pack years smoked. Conclusion A history of cigarette smoking in patients with new-onset adult asthma predicts an increase in asthma severity during the first 2 years of the disease in a dose-dependent manner.