Predictors of accelerated decline in lung function in adult-onset asthma

Abstract

Little is known about the prognosis of adults with new-onset asthma. Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s (FEV). However, risk factors for accelerated decline in lung function have not yet been identified.We aimed to identify these risk factors in a prospective 5-year follow-up study in 200 adults with newly diagnosed asthma. In the current study, clinical, functional and inflammatory parameters were assessed annually for 5 years. Linear mixed-effects models were used to identify predictors.Evaluable lung function sets of 141 patients were available. Median (interquartile range) change in post-bronchodilator FEV was -17.5 (-54.2 to +22.4) mL per year. Accelerated decline in FEV was defined by the lower quartile of decline (>54.2 mL per year). Nasal polyps, number of blood and sputum eosinophils, body mass index, and level of exhaled nitric oxide were univariably associated with decline in lung function. Only the latter two were independently associated. Using cut-off values to identify patients at highest risk showed accelerated decline in FEV in all patients with combined exhaled nitric oxide fraction () ≥57 ppb and body mass index (BMI) ≤23 kg·mWe conclude that adults with new-onset asthma with both high levels of exhaled nitric oxide and low BMI are at risk of accelerated decline in lung function.

Increase in blood eosinophils during follow-up is associated with lung function decline in adult asthma

“…Neither could we confirm the results of Lange [3] or Ulrik [10] showing that smoking is associated with greater lung function decline which could be attributed to the small proportion (17%) of smokers in our population, compared to more than 50% in theirs, leading to a lack of significance. Coumou [49] showed that increased FENO levels were associated with accelerated FEV 1 decline, which was not confirmed by our results. This could be explained by the differences in the population studied with a population with less severe asthmatics, less atopic, and with lower pack-year for Coumou as compared to ours, or the difference in treatment regimens.…”

“…Late onset of asthma, longer disease duration, frequent asthma symptoms and severe exacerbations [47], airway hyperresponsiveness (AHR), smoking, blood and sputum eosinophilia and genetic predisposition could influence lung function decline in asthma [48]. Also, FENO was found to be linked to accelerated declines in asthma [49]. Late onset, highlighted as a risk factor for accelerated decline by some authors, was not confirmed by our analysis.…”

Combined value of exhaled nitric oxide and blood eosinophils in chronic airway disease: the Copenhagen General Population Study

“…Previous studies have shown an increased FeNO level and blood eosinophil count to be independently associated with increased disease severity and acute attacks among patients with asthma and COPD [12,16,[23][24][25][26]. However, the additive value of combining these two biomarkers has not been investigated extensively.…”

Potential Role of Cellular Senescence in Asthma

“…Even with the highest step of standardized treatment, in which targeted therapies like anti-IgE, anti-IL5, anti-IL5R, and anti-IL4R antibodies would be applied, uncontrolled asthma symptoms and exacerbation still frequently exist in some patients (Israel and Reddel, 2017;Chipps et al, 2018). These patients with difficult-to-treat asthma often have higher mortality and lower lung function (McGeachie et al, 2016;Coumou et al, 2018). Furthermore, with increasing morbidity, difficult-totreat asthma might explain the stalled reduction in global asthma mortality (Ebmeier et al, 2017).…”