Association between antibiotics and asthma risk among adults aged over 40: a nationally representative retrospective cohort study

Abstract

Background Several previous studies reported that antibiotic exposure in early life could lead to asthma in early childhood. However, the association between antibiotic use and the risk of asthma in the adult population is yet unclear. Our study aims to investigate the association between antibiotic use and asthma in adults. Methods National Health Insurance Service-Health Screening Cohort data, which included 40 years or older aged subjects who have health screening examination data in 2005–2006, were used. Antibiotic exposure was examined from 2002 to 2006 and in total 256,698 participants with a mean age of 55.66 years were followed up from 2007 to 2019. During the follow-up period, 47,500 participants occurred asthma. To assess this association between antibiotic use and newly diagnosed asthma, the multivariable cox proportional hazards regression model was used. The considered covariates included residence status, body mass index, the number of healthcare visits, previous atopic dermatitis history, previous allergic rhinitis history, and infectious diseases. Results Participants with antibiotics use for ≥ 91 days showed a higher risk of asthma (adjusted hazard ratio [aHR] 1.88, 95% confidence interval [CI] 1.77-2.00), with a clear dose-dependent association (p for trend < 0.001). Furthermore, ≥ 4 antibiotic classes used group had an increased risk of asthma (aHR 1.67, 95% CI 1.58–1.76) than those who used only one antibiotic class. In our sensitivity analysis with wash-out period and shifting the index date, increased risk of asthma incidence and clear dose-response relationship according to antibiotics use have remained. Conclusions The clear dose-response pattern in antibiotics use and asthma may suggest that the management of proper antibiotic use in adults may lower the risk of asthma in the future.