Page 166 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
onset asthma?’ is addressed. Asthma remission (no asthma symptoms for ≥1 year and no asthma medica on use for ≥1 year) occurred in 27 pa ents (15.8%) at 5-year follow-up. In a mul variable logis c regression analysis, bronchial hyperresponsiveness and nasal polyps were independent predictors. Combined in a predic on model, the presence of nasal polyposis or moderate-severe bronchial hyperresponsiveness gives a probability of asthma remission close to nil. Common pathophysiologic mechanisms, related to eosinophilic in amma on, might play a role in the chronicity of both asthma and nasal polyps. With our data, early recogni on of pa ents with persistent asthma is possible and might o er op ons for adapted management strategies.
In Chapter 7 factors associated with an increase in asthma severity a er 2 years follow-up of the Adonis-study are inves gated. 128 pa ents completed two years of follow-up. 17 pa ents (13.3%) showed an increase in asthma severity, whereas 53 pa ents (41.4%) showed a decrease. Mul ple regression equa ons showed that only the number of pack years smoked was independently associated with an increase in asthma severity with an OR 1.4 (95% CI 1.02-1.91) for every 10 pack year smoked. These results imply that adults with new-onset asthma and a posi ve smoking history are at risk of developing severe disease and might be candidates for early-targeted interven ons.
Finally, in Chapter 8 predictors of asthma exacerba ons in smokers and never smoker are addressed. Therefore we selected (ex)smoking (n=83) and never smoking (n=70) pa ents with severe asthma from a cohort of 571 adult-onset asthma pa ents. Frequent exacerba ons (≥3 oral cor costeroid (OCS) bursts in the previous year) in (ex)smokers were independently associated with ICS dose (OR 1.2, 95%CI: 1.1-1.3) and blood neutrophil count (OR 1.5, 95%CI: 1.2-2.1). In never smokers frequent exacerba ons were independently associated with blood eosinophil count (OR 18.9, 95%CI: 1.8-202.1). These di erent predictors of frequent exacerba ons in never smoking and (ex)smoking pa ents with severe asthma suggest di erent types of systemic background in amma on might play a role in the ae ology of exacerba ons.
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