Page 123 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

PREDICTORS FOR THE DEVELOPMENT OF PROGRESSIVE SEVERITY IN NEW-ONSET ADULT ASTHMA
INTRODUCTION
Adult-onset asthma is a heterogeneous disease with a variable clinical course. The disease ranges from very mild to very severe.1 The majority of these pa ents have mild or intermi ent asthma.1;2 However, a propor on of pa ents develops more severe asthma over me.1 Characteris cs of pa ents with severe, adult-onset asthma are now well described in several cross-sec onal studies. We previously reported that these pa ents are more o en non-atopic, and have persistent sputum eosinophilia, higher blood neutrophil counts and more nasal polyps.3 Other authors also concluded that pa ents with the adult-onset asthma phenotype are less o en atopic4 and have more sputum eosinophilia5 compared to pa ents with the childhood-onset asthma phenotype. Adult-onset asthma pa ents also su er from respiratory infec ons4 more o en and many have persistent air ow limita on.4;5 Par cularly non-atopic males with adult-onset asthma seem to be at risk for persistent air ow limita on,6 which is possibly related to persistent infec on with Chlamydia pneumonia.7 This suggest that severe adult-onset asthma is a dis nct phenotype.3
The natural history of disease severity a er the diagnosis of adult-onset asthma has never been prospec vely evaluated, and predictors for the development of severe asthma are s ll unknown. Iden ca on of pa ents at risk for severe asthma at disease onset might be important for early therapeu c interven on.8
In the present study we hypothesized that speci c predictors for deteriora on of adult-onset asthma can be iden ed at asthma onset. Therefore, the aim of this study was to prospec vely iden fy the predictors of increase in asthma severity in a cohort of pa ents with new-onset adult asthma.
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