Determinants of persistent asthma in young adults

Abstract

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.

Association between tobacco product use and asthma among US adults from the Population Assessment of Tobacco and Health (PATH) Study waves 2–4

“…Other cross-sectional research has also shown that smoking was associated with poor asthma control,10 11 13 and unadjusted prospective studies have also indicated that smoking predicted poor asthma control and asthma exacerbation over time,46 47 but these studies also did not remove people with COPD or adjust for cumulative past smoking and other smoke exposures. In contrast, at least one study that carefully controlled for these factors did not show an association between smoking and new asthma48; rather, similar to our study, use of controller medications at baseline was associated with persistence of asthma 48…”

“…In contrast, at least one study that carefully controlled for these factors did not show an association between smoking and new asthma 48 ; rather, similar to our study, use of controller medications at baseline was associated with persistence of asthma. 48 …”

Asthma remission: what is it and how can it be achieved?

“…Of these, five studies exclusively included new adultonset asthma. 29,[38][39][40][41] Although the remaining nine studies included both adult-and childhoodonset asthma, [42][43][44][45][46][47][48][49][50] the participants were adults at the time of enrolment. Tupper et al included 62% adult-onset asthma and 38% childhood-onset asthma, and this report includes only data from the former group.…”

Asthma Remission by Age at Diagnosis and Gender in a Population-Based Study

“…3,7,9 Intermediate-diagnosed asthma (12-39 years) was in remission in 17.9% of subjects, which settles between earlier findings. 11,30 The diagnosis-age definition in this group reflects quite well those of adult-onset or late-onset asthma in previous studies comparing asthma by age of onset because older subjects have been left out in most of them. 25,30 Interestingly, exercise 2 to 3 times per week was the only significant risk factor of nonremission in this group, which however lost its significance if subjects reporting current asthma medication use but not symptoms were considered as remitted.…”

“…Other studies have similarly found only few risk factors of nonremission in subjects with similar diagnosis age: nasal polyps, allergic sensitization, worse lung function at baseline, inhaled corticosteroid use. 10,11,17,30 Daily physical activity has also been found to decelerate the loss of lung function in the long term in adult-onset asthma. 31 Only 5% of subjects with late-diagnosed asthma were currently in remission.…”