The first year of treatment predicts the prognosis of asthma over 25 y—A prospective study

Abstract

Background: An investigator-driven, real-life follow-up study of adult-onset steroidnaïve, newly diagnosed asthma (162 patients) to investigate the treatment results over the 25-year course of the disease and whether the first treatment year's forced expiratory volume in one second (FEV 1) predicts the long-term prognosis. Methods: Eighty-three per cent of the 133 living patients participated in the 25-year examinations. At this visit, basic asthma examinations including lung function, as well as questionnaires for health-related quality of life (HRQoL), GINA and the Asthma Control Test, were used for evaluation. The use of medication and remission was verified. Results: There was no statistically significant change in mean FEV 1 % predicted (FEV 1 %) from baseline to the 25-year control. The changes in FEV 1 % during the first year predicted the results at the end of follow-up. Normal FEV 1 % at the end of the first year predicted normal FEV 1 , and below-normal FEV 1 % at 1 year predicted below-normal FEV 1 % at 25 years. Twenty-nine patients (26.4%) had discontinued their medication, and six (5.5%) used ICS periodically. Clinical remission was reached by 16.4% of the patients, and 7.6% reached functional remission. The general HRQoL remained unchanged. Conclusion: In adult-onset asthma, the level of FEV 1 reached during the first treatment year seems to predict the later lung function level. One quarter of the patients discontinued the asthma treatment, but their HRQoL was better than that of those continuing to use ICS. Clinical remission was reached by 16% of the patients, which is in concordance with other studies.

Age at asthma diagnosis is related to prevalence and characteristics of asthma symptoms

“…Asthma beginning in childhood is usually associated with good treatment response and prognosis, whereas asthma beginning in adulthood is more often a chronic disease. 6,10,11,13,24 We examined asthma symptom prevalence in adults ever being diagnosed with asthma by a physician. Our hypothesis was that adults with adult-diagnosed asthma would be more symptomatic than adults with child-diagnosed asthma.…”

Asthma Remission by Age at Diagnosis and Gender in a Population-Based Study

“…2,3,5,7,9 In contrast to child-onset asthma, only 3% to 17% of adultonset asthma have remitted 5 to 25 years after the diagnosis. [10][11][12][13][14][15][16][17][18][19] As well as being more frequently persistent, 9 adult-onset asthma is more often associated with faster loss of lung function and poorer disease control than child-onset asthma. 13,20,21 In adults under 50 years of age, female gender, smoking, allergic sensitization, high body mass index (BMI), and increasing age are commonly reported risk factors of nonremission or more inadequate control of asthma symptoms, without specific knowledge of asthma age of onset.…”

The first impression counts for lung function: One year to make a difference in asthma prognosis

“…1 In the current highlighted study by Kauppinen et al, published in this issue of the journal, the authors endeavoured to investigate long-term treatment results in newly diagnosed asthma in adults. 2 This study has the advantage of being a real-life 25 years-long prospective study that included only ICS-naïve asthmatics, who were One key message that could be translated into clinical practice is the importance of the first year of the ICS-based asthma treatment strategy. These steroid-naïve newly diagnosed adult asthmatics were treated with high-dose ICS, which was then decreased, according to the Finnish Asthma Programme.…”

“…In the current highlighted study by Kauppinen et al, published in this issue of the journal, the authors endeavoured to investigate long‐term treatment results in newly diagnosed asthma in adults . This study has the advantage of being a real‐life 25 years‐long prospective study that included only ICS‐naïve asthmatics, who were systematically evaluated, including lung function, asthma control and health‐related (HR) quality of life (QoL) at the outset.…”