A 12-year prognosis of adult-onset asthma: Seinäjoki Adult Asthma Study

Tuomisto, Leena E.; Ilmarinen, Pinja; Niemelä, Onni; Haanpää, Jussi; Kankaanranta, Terhi; Kankaanranta, Hannu

doi:10.1016/j.rmed.2016.06.017

Cited by 65 publications

(108 citation statements)

References 33 publications

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“…The findings are clinically significant, since remission rate in adult onset asthma is low [7] and most patients suffer from asthma for decades. The linearity of the effect of physical activity on lung function remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The patients were treated and monitored according to Finnish Asthma Program guidelines [19] either in the specialized care or in primary care. The collection of research data has been previously reported [7,9,10,20]. At diagnosis, data was collected on lung function, blood eosinophils, the initial pharmacotherapy, and asthma symptoms by Airways Questionnaire 20 (AQ20) [21].…”

Section: Methodsmentioning

confidence: 99%

“…Childhood asthma is often an atopic disease characterized by high numbers of bronchial eosinophils and high serum levels of IgE with a good response to glucocorticoid treatment. In contrast, patients with disease onset at adulthood have often more severe asthma that rarely remits [7]. Recently, asthma diagnosed at adult-age has been shown to constitute a majority among all new cases of asthma [8], and it seems that several lifestyle factors such as cigarette smoking and obesity are major factors in adult-onset asthma [6,9].…”

Section: Introductionmentioning

confidence: 99%

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Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Loponen

Ilmarinen

Tuomisto

et al. 2018

European Clinical Respiratory Journal

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Background: There is a lack of knowledge on the association between daily physical activity and lung function in patients with asthma. Objective: This study aims to examine the association between daily physical activity and asthma control, lung function, and lung function decline in patients with adult-onset asthma. Design: This study is part of Seinäjoki Adult Asthma Study (SAAS), where 201 patients were followed for 12 years after asthma diagnosis. Daily physical activity was assessed at follow-up by a structured questionnaire and used to classify the population into subgroups of low (≤240 min) or high (>240 min) physical activity. Three spirometry evaluation points were used: 1. diagnosis, 2. the maximum lung function during the first 2.5 years after diagnosis (Max0-2.5), 3. follow-up at 12 years. Results: High physical activity group had slower annual FEV1 (p<0.001) and FVC (p<0.018) decline. Additionally, the high physical activity group had higher FEV1 values at follow-up, and higher FEV1/FVC ratios at follow-up and diagnosis. There was no difference in BMI, smoking, medication, or frequency of physical exercise between high and low physical activity groups. Differences remained significant after adjustments for possible confounding factors. Conclusion: This is the first demonstration of an association between long-term FEV1 decline and daily physical activity in clinical asthma. Low physical activity is independently associated with faster decline in lung function. Daily physical activity should be recommended in treatment guidelines in asthma.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Loponen

Ilmarinen

Tuomisto

et al. 2018

European Clinical Respiratory Journal

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“…A review has shown that adult-onset asthma has a worse prognosis and a lower response to standard asthma treatment than childhood-onset asthma [8]. In a 12-year follow-up study of adult-onset asthma elevated BMI at baseline, smoking and current allergic or persistent rhinitis predicted uncontrolled asthma, and elevated blood eosinophils and good lung function (FEV1) at baseline protected from uncontrolled asthma [9]. Remission rates vary widely due to varying definitions of asthma and observation time but generally early-onset asthma has a substantially higher remission rate than late-onset asthma [10].…”

Section: Introductionmentioning

confidence: 99%

Determinants of persistent asthma in young adults

Traulsen

Halling

Bælum

et al. 2018

European Clinical Respiratory Journal

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Objective: The aim of the study was to evaluate determinants for the prognosis of asthma in a population-based cohort of young adults.Design: The study was a nine-year clinical follow up of 239 asthmatic subjects from an enriched population-based sample of 1,191 young adults, aged 20–44 years, who participated in an interviewer-administered questionnaire and clinical examination at baseline in 2003–2006. From the interview, an asthma score was generated as the simple sum of affirmative answers to five main asthma-like symptoms in order to analyse symptoms of asthma as a continuum. The clinical examination comprised spirometry, bronchial challenge or bronchodilation, and skin prick test.Results: Among the 239 individuals with asthma at baseline 164 (69%) had persistent asthma at follow up, while 68 (28%) achieved remission of asthma and seven (3%) were diagnosed with COPD solely. Determinants for persistent asthma were use of medication for breathing within the last 12 months: Short-acting beta-adrenoceptor agonists (SABA) only (OR 3.39; 95%CI: 1.47–7.82) and inhaled corticosteroids (ICS) and/or long-acting beta-adrenoceptor agonists (LABA) (8.95; 3.87–20.69). Stratified by age of onset determinants for persistence in individuals with early-onset asthma (age less than 16 years) were FEV₁ below predicted (7.12; 1.61–31.50), asthma score at baseline (2.06; 1.15–3.68) and use of ICS and/or LABA within 12 months (9.87; 1.95–49.98). In individuals with late-onset asthma the determinant was use of ICS and/or LABA within 12 months (6.84; 2.09–22.37).Conclusions: Pulmonary function below predicted, severity of disease expressed by asthma score and use of ICS and/or LABA were all determinants for persistent early-onset asthma, whereas only use of ICS and/or LABA was a determinant in late-onset asthma. A high asthma score indicated insufficient disease control in a substantial proportion of these young adults.

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“…11 Briefly, asthma was diagnosed by a specialized respiratory physician during the period 1999 to 2002 on the basis of typical clinical symptoms and confirmed by objective lung function measurements. 11,12 The main diagnostic features of asthma in each cluster are presented in Table E1 in this article's Online Repository at www.jaci-inpractice.org. Smokers and patients with comorbidities were not excluded.…”

Section: Patients and Study Designmentioning

confidence: 99%

Cluster analysis on longitudinal data of patients with adult-onset asthma

Ilmarinen¹,

Tuomisto²,

Niemelä

et al. 2016

5.1 Airway Pharmacology and Treatment

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What is already known about this topic? Many phenotypes of asthma have been identified in previous cluster analyses, mostly on the basis of cross-sectional data with limited inclusion of patients. Some studies have provided short-term 1-to 3-year prognosis for the phenotypes.What does this article add to our knowledge? This is the first study that reports long-term 12-year prognosis for clusters of adult-onset asthma starting from diagnosis. We report different disease prognoses for smoking, obesity-related, female, atopic, and nonrhinitic asthma.How does this study impact current management guidelines? Information on long-term outcome of asthma can be used to inform and motivate patients. We show the poorest outcome and the most unmet needs in the therapy of smoking and obesity-related asthma, suggesting need for special guidance.BACKGROUND: Previous cluster analyses on asthma are based on cross-sectional data. OBJECTIVE: To identify phenotypes of adult-onset asthma by using data from baseline (diagnostic) and 12-year follow-up visits. METHODS: The Seinäjoki Adult Asthma Study is a 12-year follow-up study of patients with new-onset adult asthma. K-means cluster analysis was performed by using variables from baseline and follow-up visits on 171 patients to identify phenotypes. RESULTS: Five clusters were identified. Patients in cluster 1 (n [ 38) were predominantly nonatopic males with moderate smoking history at baseline. At follow-up, 40% of these patients had developed persistent obstruction but the number of patients with uncontrolled asthma (5%) and rhinitis (10%) was the lowest. Cluster 2 (n [ 19) was characterized by older men with

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A 12-year prognosis of adult-onset asthma: Seinäjoki Adult Asthma Study

Abstract: During a 12-year follow-up, remission of adult-onset asthma was rare occurring in only 3% of patients. The majority of patients (66%) presented either with uncontrolled or partially controlled asthma. This study is registered at ClinicalTrials.gov with identifier number NCT02733016.

Cited by 65 publications

References 33 publications

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Determinants of persistent asthma in young adults

Cluster analysis on longitudinal data of patients with adult-onset asthma

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