Different Severity and Severity Predictors in Early-Onset and Late-Onset Asthma: A Taiwanese Population-Based Study

Abstract

Background: Late-onset asthma has been shown to be more severe than early-onset asthma in clinic-based studies. However, population-based studies are scarce, and the predictors of severity have been less studied. Objectives: To determine asthma severity and severity predictors regarding age at onset. Methods: A cross-sectional questionnaire survey was conducted among parents of children from 94 schools in Taiwan in 2004. Asthma severity was defined as short-acting β₂-agonist (SABA), inhaled corticosteroid (ICS) and health care use in the last year. Information on age at onset, demographics, heredity and home exposure was collected. Ordered logistic or logistic regression was used for determining the associations between risk factors and severity. Results: Participants aged 26-50 years were included, resulting in 21,057 (67.8%) participants. Among them, 449 reported ever having had physician-diagnosed asthma, and 381 of those subjects answered the question on age at asthma onset. The risks of rescue SABA, ICS and health care use were generally higher among late-onset (13-50 years) than early-onset (0-12 years) asthmatics. Use of SABA and health care increased from childhood-onset, adolescent- or young adult-onset to adult-onset asthma. Allergic rhinitis was positively associated with SABA use (OR, 9.08; 95% CI, 1.06-77.99) and ICS use (OR, 5.08; 95% CI, 1.47-17.52) in early-onset asthma. Dehumidifier use was negatively associated with SABA use (OR, 0.50; 95% CI, 0.29-0.87) and ICS use (OR, 0.38; 95% CI, 0.19-0.78) in late-onset asthma. Conclusions: In adults, late-onset asthma was more severe than early-onset asthma. Severity, as indicated by SABA and ICS use, was positively associated with allergic rhinitis in early-onset asthma and negatively associated with dehumidifier use in late-onset asthma.

Co‐morbidities in severe asthma: Clinical impact and management

“…However, early onset of severe asthma is typically associated with allergic sensitization and allergic rhinoconjuctivitis (Table ) . Patients with early‐onset allergic asthma tend to have a clear association between allergen exposure and symptoms, as well as between upper and lower airway symptoms . Whereas in late‐onset severe asthma, patients may frequently have allergic sensitization to aeroallergens, but in most cases their symptoms do not seem to be aggravated by allergen exposure or associated with symptoms of allergic rhinitis …”

“…23,24 Patients with early-onset allergic asthma tend to have a clear association between allergen exposure and symptoms, 25 as well as between upper and lower airway symptoms. 26 Whereas in late-onset severe asthma, patients may frequently have allergic sensitization to aeroallergens, but in most cases their symptoms do not seem to be aggravated by allergen exposure or associated with symptoms of allergic rhinitis. [26][27][28] Patients with allergic rhinitis report poorer asthma control, more exacerbations and emergency visits 29 and have more difficulty achieving symptom control.…”

“…26 Whereas in late-onset severe asthma, patients may frequently have allergic sensitization to aeroallergens, but in most cases their symptoms do not seem to be aggravated by allergen exposure or associated with symptoms of allergic rhinitis. [26][27][28] Patients with allergic rhinitis report poorer asthma control, more exacerbations and emergency visits 29 and have more difficulty achieving symptom control. 30 Treating coexisting allergic rhinitis improves asthma control and reduces healthcare resource utilization.…”

The evidence on tiotropium bromide in asthma: from the rationale to the bedside

“…The latter should include, among others, the minimization of adverse events while providing the optimal treatment coverage, the prevention of lung function decline and reduced lung growth in children and, most importantly, the prevention of recurrent exacerbation and especially severe relapses leading to emergency department access and hospitalization [4, 30]. Major risk factors related to future exacerbations are represented by a previous history of exacerbations, increased use of oral corticosteroids and rescue medications, obesity, worse lung function, poor adherence to inhaled therapy, low Asthma Control Questionnaire (ACQ-7) score, co-morbid diseases, chronic sinusitis and cigarette smoke (Table 1) [3, 31–43]. Despite poor inhaler technique has been demonstrated to be related to worse asthma control [44, 45], most of the analyses designed to evaluate risk factors predictive of future exacerbations did not include it in the regressions [37].…”

“…ACQ-7, Asthma control questionnaire; SABA, Short acting β2 agonists; mo, months. Data are from [3, 31–43] …”