Page 106 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
RESULTS
Clinical data of 170 pa ents (85% of ini al cohort, see Figure 1) were available at 5-year follow-up (mean follow-up dura on 4.8±0.6 years); of which 108 (64%) pa ents underwent an evalua on in the lung func on laboratory, 27 (16%) pa ents were contacted by telephone, and from 35 (21%) pa ents data were obtained from the primary care database. Addi onal data collected at yearly intervals were obtained from 75% of the pa ents. Pa ents who were lost to follow-up di ered slightly from the rest of the cohort with respect to a younger age and lower incidence of nasal polyposis, there was no di erence in smoking status (data not shown).
INCIDENCE AND CHARACTERISTICS OF PATIENTS WITH ASTHMA REMISSION OR PERSISTENCE
Clinical remission of asthma occurred in 27 out of 170 pa ents (15.9%). Remission was observed in the course of me, the median dura on from baseline to remission was 45 months (range 9-45 months).
At baseline, pa ents with persistent asthma were older, had worse asthma control (asthma control ques onnaire (ACQ)-score 1.34 vs 0.89, p=0.026), required higher doses of inhaled cor costeroids (median u casone equivalent 313 μg vs 250 μg, p=0.007), had more severe bronchial hyperresponsiveness (PC20-methacholine 2.7 vs 5.8 mg/ml, p=0.003), were more o en diagnosed with nasal polyps (25% vs 0%, p=0.004) and had higher levels of blood neutrophils as compared to pa ents who experienced clinical remission a er 5 years. There was no di erence between the two groups in lung func on, percentage of eosinophils in blood or sputum, or level of exhaled nitric oxide (Table 1).
At 5-year follow-up, pa ents in remission showed a signi cant reduc on in ICS dose and ACQ-score. These pa ents also showed a reduc on in PC20-methacholine over me, resul ng in the absence of bronchial hyperresponsiveness in the majority of pa ents. Pa ents with asthma persistence did not show a signi cant change in PC20-methacholine, but showed an increase in persistent airway obstruc on as re ected by a lower post-bronchodilator FEV1/FVC. Neither group showed signi cant changes in markers of eosinophilic in amma on, however pa ents with persistent asthma showed an increase in sputum neutrophils (Table 2). In a post hoc analysis, pa ents with asthma persistence with and without nasal polyps were examined in more detail (Table 3). Furthermore, the observed increase of sputum neutrophil levels in pa ents with asthma persistence appeared to be only present in pa ents without nasal polyps (p=0.004, n=30) and not in those with nasal polyps (p=0.122, n=15).
PREDICTORS OF ASTHMA REMISSION AND PERSISTENCE
Univariate logis c regression analysis showed that age, ICS-dose, ACQ-score, PC20-methacholine and nasal polyps were signi cant predictors of asthma outcome. Mul variable logis c regression showed that more severe bronchial hyperresponsiveness (lower PC20-methacholine,
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