Abstract
BackgroundPossible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO).MethodsA total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40–59.9, and ≥ 60 years. The cohorts were analyzed separately.ResultsBDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar.ConclusionBy using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached.Trial registrationSeinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016.
Highlights
Asthma is a chronic, heterogeneous disease, characterized by airway inflammation and variable bronchial obstruction [1]
In reflection to the proposed criteria of asthmaCOPD overlap (ACO), our aim was to evaluate whether bronchodilator response (BDR) varies with age at diagnosis of adult-onset asthma, and how large proportion of patients fulfil the criterion of 400 measured as absolute change (mL) in BDR, by using data of two, well-described, real-world asthma cohorts
Clinical characteristics by age in Seinäjoki Adult Asthma Study (SAAS) cohort There were no differences in gender distribution between the 3 groups with different age at asthma diagnosis, but Body mass index (BMI) increased by age (Table 1)
Summary
Heterogeneous disease, characterized by airway inflammation and variable bronchial obstruction [1]. Tommola et al Respiratory Research (2020) 21:179 high reversibility of obstruction (> 400 mL BDR in FEV1) or a diagnosis of asthma before the age of 40 years [7]. Smoking among patients with asthma is reported to be nearly as common as among healthy population, up to 26% of asthmatics being smokers [18,19,20] This obligates us to pay special attention to the differential diagnostics between asthma, COPD and ACO, especially considering the clinical circumstances where patients have severe symptoms but no previous diagnoses. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthmaCOPD overlap (ACO)
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