Page 30 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
level 79. A case-control study with ten year follow-up evaluated risk factors for emergency room visits and found FEV1 <65%, ex- or current smoking and having more symptoms as independent risk factors.80 Addi onally, several studies have been performed in a mixed popula on of adult pa ents with both childhood and adult-onset asthma. Ten Brinke et al. inves gated the in uence of several comorbidi es on the occurrence of frequent exacerba ons. They found psychological dysfunc oning, recurrent respiratory infec ons, gastro-oesophageal re ux, severe chronic sinus disease and obstruc ve sleep apnoea to be associated with frequent exacerba ons in di cult-to-treat asthma pa ents 81. Others reported pa ents with uncontrolled asthma were at higher risk for asthma exacerba ons on the short term (1-2 weeks) 69, 82. Whereas for exacerba on risk on the long run besides uncontrolled asthma also higher medica on use, low FEV1, obesity 83 and recent exacerba ons84 are predictors of exacerba ons.
DETERMINANTS OF ASTHMA CONTROL IN OCCUPATIONAL ASTHMA
The most important determinant of asthma control and severity in pa ents with occupa onal asthma is con nuing exposure to causa ve agents. Exposure to HMW or LMW asthmagens in the past year was associated with uncontrolled asthma in a large European study. Past 10 year occupa onal exposure was even stronger associated with uncontrolled asthma 85. Another study (n=25) where half of the pa ents ceased exposure to the asthmagen inves gated asthma symptoms, severity and health expenditure during 1 year follow-up. All subjects that con nued to be exposed remained symptoma c and used asthma medica on, whereas half of those who ceased exposure had been asymptoma c for at least half a year. Although both groups showed an improvement of asthma severity, the improvement was more marked in the group that ceased exposure 86.
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