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New perspectives on difficult asthma; sex and age of asthma-onset based phenotypes

New perspectives on difficult asthma; sex and age of asthma-onset based phenotypes
New perspectives on difficult asthma; sex and age of asthma-onset based phenotypes

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.

Age of onset, Comorbidity, Difficult asthma, Lung function, Phenotypes, Sex, Smoking
2213-2198
3396-3406.e4
Azim, Adnan
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Freeman, Anna
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Lavenu, Audrey
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Mistry, Heena
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Haitchi, Hans Michael
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Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Cheng, Yueqing
901cb9ba-bdac-465c-b11d-124919b973e8
Thirlwall, Yvette
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Harvey, Matthew
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Barber, Clair
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Pontoppidan, Katarina
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Dennison, Paddy
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Arshad, S. Hasan
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Djukanovic, Ratko
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Howarth, Peter
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Kurukulaaratchy, Ramesh J.
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Azim, Adnan
87c31e0e-c9bf-4258-9ae9-889e2382e7ba
Freeman, Anna
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Lavenu, Audrey
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Mistry, Heena
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Haitchi, Hans Michael
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Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Cheng, Yueqing
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Thirlwall, Yvette
382d3468-33f2-44eb-91af-64fd9b5d8f07
Harvey, Matthew
d34fdc10-eecc-45be-aa7b-e2cd70318617
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Pontoppidan, Katarina
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Dennison, Paddy
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Arshad, S. Hasan
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Djukanovic, Ratko
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Howarth, Peter
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Kurukulaaratchy, Ramesh J.
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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).

Record type: Article

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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More information

Accepted/In Press date: 26 May 2020
e-pub ahead of print date: 13 June 2020
Published date: 1 November 2020
Keywords: Age of onset, Comorbidity, Difficult asthma, Lung function, Phenotypes, Sex, Smoking

Identifiers

Local EPrints ID: 442217
URI: http://eprints.soton.ac.uk/id/eprint/442217
ISSN: 2213-2198
PURE UUID: a4dd444e-ac37-4d02-8e07-feae2d3e93fd
ORCID for Hans Michael Haitchi: ORCID iD orcid.org/0000-0001-8603-302X
ORCID for Clair Barber: ORCID iD orcid.org/0000-0001-5335-5129
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612
ORCID for Ramesh J. Kurukulaaratchy: ORCID iD orcid.org/0000-0002-1588-2400

Catalogue record

Date deposited: 09 Jul 2020 16:30
Last modified: 15 Sep 2021 02:10

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Contributors

Author: Adnan Azim
Author: Anna Freeman
Author: Audrey Lavenu
Author: Heena Mistry
Author: Colin Newell
Author: Yueqing Cheng
Author: Yvette Thirlwall
Author: Matthew Harvey
Author: Clair Barber ORCID iD
Author: Katarina Pontoppidan
Author: Paddy Dennison
Author: S. Hasan Arshad
Author: Peter Howarth

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