Page 14 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
ADULT-ONSET ASTHMA, A HETEROGENEOUS DISEASE
ASTHMA PHENOTYPES
Adult-onset asthma is a heterogeneous disease with a variable clinical picture and a
complex pathophysiology.10, 28 Therefore the term adult-onset asthma can be regarded as an
umbrella term for several dis nct airway diseases, so called asthma phenotypes.29 Early day
phenotyping of asthma was based on clinical recogni on of subtypes6, 23, 30 and more recently
an integra ve sta s cal approach using cluster analysis has shown a wide variety of asthma-
phenotypes.8, 31 These phenotypes can be based on several aspects of the disease, most used
are either clinical and physiological features, asthma triggers or airway in amma on type.28, 32
Well known clinical phenotypes are for instance obesity associated asthma,31 asthma with
chronic sinusi s and nasal polyps,33 cough-variant asthma,34 asthma with persistent air ow
limita on35 and asthma with frequent exacerba ons36; trigger associated phenotypes like
or neutrophilic asthma.40 Asthma phenotypes are not mutually exclusive in a patient; considerable
occupa onal asthma,17 smoking related asthma,37 atopic or non-atopic asthma38, 39 and nally 40
inov earmlapmeaxtiostrsybpehtweneoentytphesms.uFcighuares 2eogsivinesopanhiolivceorvrienweuotfrothpehdilifcfearsetnhtmchai.ldhAosotdh-manadpahdeunlto-otynpsets
are not mutually exclusive in a pa ent; considerable overlap exists between them. Figure 2
asthma phenotypes.32
gives an overview of the di erent childhood- and adult-onset asthma phenotypes.32
Figure 2. Schematic view of different asthma phenotypes, divided by childhood or adult-onset and eosinophilia. Adapted from Hekking and Bel.32
12
Pathophysiology