Page 116 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
into the prognosis of asthma pa ents should lead to closer monitoring of these pa ents in order to improve asthma outcomes. Secondly, treatable traits in these pa ents including eosinophilic airway in amma on and nasal polyps should be addressed and treated.14 Biologicals targe ng type 2 in amma on that have been shown to be e ec ve in both condi ons might be promising, although the e ect of such treatment on the prognosis and persistence of asthma remains to be con rmed. Finally, all adults with newly diagnosed asthma should be evaluated for nasal polyposis, preferably by means of nasal endoscopy, because of their strong prognos c value. This advice should also be included in the GINA guidelines, where an examina on of the upper airway is recommended in pa ents with severe asthma only.15
In conclusion, this study shows a rela vely high remission rate in adult-onset asthma within the rst 5 years of the disease, which is reassuring. However, a combina on of nasal polyposis and moderate to severe bronchial hyperresponsiveness (PC20-methacholine ≤ 1.0 mg/ml) at the me of asthma diagnosis reduces the chance of remission to almost zero. Recogni on of these at risk pa ents at an early stage is necessary because both condi ons are associated with impaired quality of life, reduced workplace produc vity, and substan al medical treatment costs. Since eosinophilic airway in amma on seems to play a role in the persistence and chronicity of both asthma and nasal polyposis, this might o er op ons for early interven on with biologicals targe ng key drivers of type 2 in amma on.48, 49
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