Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy

Abstract

The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.

Obesity and Asthma

“…Results of prior clinical trials may not be as relevant as our population continues to become more obese. Moreover, since obese patients with late-onset asthma 75 usually lack eosinophilia and often have a neutrophilic phenotype, new therapies for type 2 low asthma in the obese are needed. As of now, therapies treating obese asthma follow the same guidelines and recommendations for lean asthma.…”

Epidemiology of sensitization to perennial aeroallergens in adults with severe asthma in Belgium. The BEIgE study

“…We also compared the ranking of sensitizations between patients with early versus adult-onset asthma (<18 years of age vs ≥18, respectively), 6 the latter representing the majority of patients included in this study (68.9%, mean ± SEM; age of onset 30.3 ± 1.5 years, Table S1). We found a marked difference in sensitization profiles between both groups (Table S3).…”

Nasal cytology as a reliable non-invasive procedure to phenotype patients with type 2 chronic rhinosinusitis with nasal polyps

“… 7 Unfortunately, however, about 35% of patients undergoing endonasal surgery tend to relapse within the subsequent 6 months 8 with the need to perform several surgical interventions over the course of their life, without obtaining a real resolution or a real improvement in the clinical picture. In addition, up to about half of patients with CRSwNP are also affected by bronchial asthma, 9 often late-onset 10 and of greater severity: patients with severe asthma and concomitant CRSwNP are among the most frequent users of OCS, 11 and therefore potentially exposed to OCS-related side effects that are particularly dangerous for health and burdensome for health systems. 12 , 13 …”