Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Ilmarinen, Pinja; Tuomisto, Leena E.; Niemelä, Onni; Danielsson, Joanna; Haanpää, Jussi; Kankaanranta, Terhi; Kankaanranta, Hannu

doi:10.1183/13993003.02198-2015

Cited by 79 publications

(66 citation statements)

References 43 publications

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“…The patients were treated and monitored according to Finnish Asthma Program guidelines [19] either in the specialized care or in primary care. The collection of research data has been previously reported [7,9,10,20]. At diagnosis, data was collected on lung function, blood eosinophils, the initial pharmacotherapy, and asthma symptoms by Airways Questionnaire 20 (AQ20) [21].…”

Section: Methodsmentioning

confidence: 99%

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Loponen

Ilmarinen

Tuomisto

et al. 2018

European Clinical Respiratory Journal

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Background: There is a lack of knowledge on the association between daily physical activity and lung function in patients with asthma. Objective: This study aims to examine the association between daily physical activity and asthma control, lung function, and lung function decline in patients with adult-onset asthma. Design: This study is part of Seinäjoki Adult Asthma Study (SAAS), where 201 patients were followed for 12 years after asthma diagnosis. Daily physical activity was assessed at follow-up by a structured questionnaire and used to classify the population into subgroups of low (≤240 min) or high (>240 min) physical activity. Three spirometry evaluation points were used: 1. diagnosis, 2. the maximum lung function during the first 2.5 years after diagnosis (Max0-2.5), 3. follow-up at 12 years. Results: High physical activity group had slower annual FEV1 (p<0.001) and FVC (p<0.018) decline. Additionally, the high physical activity group had higher FEV1 values at follow-up, and higher FEV1/FVC ratios at follow-up and diagnosis. There was no difference in BMI, smoking, medication, or frequency of physical exercise between high and low physical activity groups. Differences remained significant after adjustments for possible confounding factors. Conclusion: This is the first demonstration of an association between long-term FEV1 decline and daily physical activity in clinical asthma. Low physical activity is independently associated with faster decline in lung function. Daily physical activity should be recommended in treatment guidelines in asthma.

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Section: Methodsmentioning

confidence: 99%

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Loponen

Ilmarinen

Tuomisto

et al. 2018

European Clinical Respiratory Journal

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“…This is driven by translocation of microbial products, including lipopolysaccharide, into the systemic circulation through a gastrointestinal mucosa made “leaky” as a result of HIV HIV-mediated inflammation of gut lymphoid tissue [59–61]. The resultant immune dysregulation is associated with end-organ damage [58,62–64], and may be important mechanistically in CLD development. HIV itself is an independent risk factor for COPD among adults [6,65,66].…”

Section: Risk Factors For Hiv-associated Chronic Lung Disease Among Amentioning

confidence: 99%

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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Purpose of review The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally-acquired HIV. Recent findings There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, where 90% of the world’s HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis are emerging as leading causes of CLD among HIV-infected adolescents in low- and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction and untreated HIV infection, particularly during critical stages of lung development. Summary Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.

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“…23,24 Recently, we showed that multimorbidity is associated with increased symptoms of asthma, which may be partly related to systemic inflammation in these patients. 25 Systemic inflammation has been associated with high steroid dose in the treatment of adult-onset asthma. 25 Therefore, multimorbidity and systemic inflammation may be relevant in turning asthma into symptomatic and steroid-resistant in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…25 Systemic inflammation has been associated with high steroid dose in the treatment of adult-onset asthma. 25 Therefore, multimorbidity and systemic inflammation may be relevant in turning asthma into symptomatic and steroid-resistant in obese patients. However, weight loss has resulted in improved symptoms, lung function, asthma control, and health status, 23 suggesting that it would benefit this subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…Cluster 3 (n [ 50) consisted mostly of nonsmoking females with good lung function at diagnosis/ follow-up and well-controlled/partially controlled asthma at follow-up. Cluster 4 (n [ 25) had obese and symptomatic patients at baseline/follow-up. At follow-up, these patients had several comorbidities (40% psychiatric disease) and were treated daily with ICS and add-on therapy.…”

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Cluster analysis on longitudinal data of patients with adult-onset asthma

Ilmarinen¹,

Tuomisto²,

Niemelä

et al. 2016

5.1 Airway Pharmacology and Treatment

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What is already known about this topic? Many phenotypes of asthma have been identified in previous cluster analyses, mostly on the basis of cross-sectional data with limited inclusion of patients. Some studies have provided short-term 1-to 3-year prognosis for the phenotypes.What does this article add to our knowledge? This is the first study that reports long-term 12-year prognosis for clusters of adult-onset asthma starting from diagnosis. We report different disease prognoses for smoking, obesity-related, female, atopic, and nonrhinitic asthma.How does this study impact current management guidelines? Information on long-term outcome of asthma can be used to inform and motivate patients. We show the poorest outcome and the most unmet needs in the therapy of smoking and obesity-related asthma, suggesting need for special guidance.BACKGROUND: Previous cluster analyses on asthma are based on cross-sectional data. OBJECTIVE: To identify phenotypes of adult-onset asthma by using data from baseline (diagnostic) and 12-year follow-up visits. METHODS: The Seinäjoki Adult Asthma Study is a 12-year follow-up study of patients with new-onset adult asthma. K-means cluster analysis was performed by using variables from baseline and follow-up visits on 171 patients to identify phenotypes. RESULTS: Five clusters were identified. Patients in cluster 1 (n [ 38) were predominantly nonatopic males with moderate smoking history at baseline. At follow-up, 40% of these patients had developed persistent obstruction but the number of patients with uncontrolled asthma (5%) and rhinitis (10%) was the lowest. Cluster 2 (n [ 19) was characterized by older men with

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Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Cited by 79 publications

References 43 publications

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Cluster analysis on longitudinal data of patients with adult-onset asthma

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