The following is the summary of “Differences Between Early- and Late-Onset Asthma: Role of Comorbidities in Symptom Control” published in the December 2022 issue of Allergy and Clinical Immunology by Turrin, et al.
Both children and adults can develop asthma for the first time. However, comorbidity load in adults with asthma, broken down by onset age, is not well understood. To examine whether or not reported comorbidities are linked with lung function and inflammatory parameters and to assess the impact of comorbidities on symptom control in 2 groups of patients with early- and late-onset asthma EOA and LOA, respectively. About 175 adult asthma patients (mean age 57.5±17.1) were recruited from their university’s asthma clinic for this cross-sectional study. Researchers classified early-onset asthma (EOA) as having an onset between 12 and 40 years of age.
Comorbidities such as rhinitis, Gastroesophageal reflux disease, obesity, Cardiovascular, and bronchiectasis were examined, with symptom control as the primary outcome. Investigators conducted a multivariable regression analysis to determine poor EOA and LOA management risk factors. Among the 175 participants, 77 (or 44%) had EOA, 98 (or 56%) had LOA, and co-morbidities’ effects varied widely between the 2. Uncontrolled asthma (P<.001), decreased Forced expiratory volume FEV1/FVC (P=.01), higher eosinophils (P=.003), and total IgE (P<.01) were all linked to rhinitis, which was more common in EOA (76 vs 53%; P=.02). Asthma management and FEV1/FVC were better in LOA patients who also suffered from rhinitis (P<.01 for both). Only in EOA were their significant correlations between IgE levels and blood eosinophils (r=0.42; P<.001) and IgE levels and FEV1/FVC (r=-0.35; P=.002). About 20% of patients in both groups were obese; however, in LOA, obesity was linked to uncontrolled illness (P=.009), decreased FEV1/FVC (P=.009), and elevated blood neutrophils (P=.03).
Multivariate analysis found that rhinitis in EOA and obesity in LOA were the strongest predictors of poor management. Control was unaffected by the presence of Gastroesophageal reflux disease, Cardiovascular comorbidities, or bronchiectasis. It is now known that persistent asthma from an early age and asthma at a later age are 2 separate phenotypes, each with its own unique inflammatory profile and collection of co-morbidities that can make it difficult to manage symptoms.
Source: sciencedirect.com/science/article/abs/pii/S2213219822008091