Azim, Adnan, Freeman, Anna, Lavenu, Audrey, Mistry, Heena, Haitchi, Hans Michael, Newell, Colin, Cheng, Yueqing, Thirlwall, Yvette, Harvey, Matthew, Barber, Clair, Pontoppidan, Katarina, Dennison, Paddy, Arshad, S. Hasan, Djukanovic, Ratko, Howarth, Peter and Kurukulaaratchy, Ramesh J. (2020) New perspectives on difficult asthma; sex and age of asthma-onset based phenotypes. The Journal of Allergy and Clinical immunology: In Practice, 8 (10), 3396-3406.e4. (doi:10.1016/j.jaip.2020.05.053).
Abstract
BACKGROUND: Asthma is a diverse condition that differs with age and sex. However, it remains unclear how sex, age of asthma-onset, and/or their interaction, influence clinical expression of more problematic adult "difficult" asthma.
OBJECTIVES: To better understand the clinical features of difficult asthma within a real-world clinical setting using novel phenotypic classification, stratifying subjects by sex and age of asthma-onset.
METHODS: Participants in a longitudinal difficult asthma clinical cohort study (Wessex AsThma CoHort of difficult asthma; WATCH), United Kingdom, (n=501) were stratified into 4 difficult asthma phenotypes based on sex and age of asthma-onset (early<18-years or adult≥18-years) and characterised in relation to clinical and pathophysiological features.
RESULTS: The cohort had more female participants (65%) but had similar proportions of participants with early or adult-onset disease. Early-onset female disease was commonest (35%), highly atopic, with good spirometry and strong associations to some physical comorbidities but highest psychophysiologic comorbidities. Adult-onset females also had considerable psychophysiologic comorbidities, highest obesity, and were least atopic. Amongst male subjects, proportionately more had adult-onset disease. Early-onset male disease was rarest (14%) but associated with worst lung function, high smoking, atopy and fungal sensitisation. Despite shortest disease duration, adult-onset males had highest use of maintenance oral corticosteroid, poor lung function and highest FeNO in spite of highest smoking prevalence.
CONCLUSION: This study shows that sex, age of asthma-onset, and their interactions influence different clinical manifestations of difficult asthma and identifies a greater risk for lung function loss and oral corticosteroid dependency associated with smoking in adult-onset male subjects.
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