Severity of adult-onset asthma - a matter of blood neutrophils and severe obesity

Abstract

BackgroundAdult-onset asthma is associated with a poor treatment response. The aim was to study associations between clinical characteristics, asthma control and treatment in adult-onset asthma. MethodsPrevious participants within the population-based Obstructive Lung Disease in Northern Sweden studies (OLIN) were in 2019–2020 invited to clinical examinations including structured interviews, spirometry, fractional exhaled nitric oxide (FeNO), skin prick test and blood sampling. In total, n = 251 individuals with adult-onset asthma (debut >15 years of age) were identified. Uncontrolled asthma was defined according to ERS/ATS and treatment step according to GINA (2019). ResultsAmong individuals with uncontrolled asthma (34%), severe obesity (16.3% vs 7.9%, p = 0.041) and elevated levels of blood neutrophils, both regarding mean level of blood neutrophils (4.25*109/L vs 3.67*109/L, p = 0.003), and proportions with ≥4*109/L (49.4% vs 33.3%, p = 0.017) and ≥5*109/L (32.1% vs 13.7%, p < 0.001) were more common than among those with controlled asthma. Adding the dimension of GINA treatment step 1–5, individuals with uncontrolled asthma on step 4–5 treatment had the highest proportions of blood neutrophils ≥5*109/L (45.5%), severe obesity (BMI≥35, 26.1%), dyspnea (mMRC≥2) (34.8%), and most impaired lung function in terms of FEV1%<80% of predicted (42.9%), FEV1<LLN (47.6%), FVC<80% of predicted (42.9%) and FVC < LLN (38.1%). No associations between level of asthma control and treatment were found regarding blood eosinophils, FeNO or allergic sensitization. ConclusionThis study indicates that in adult-onset asthma, primarily non-type-2 characteristics such as obesity and blood neutrophils associate with poor asthma control and higher doses of inhaled corticosteroids.