Clinical predictors of remission and persistence of adult-onset asthma

Publication date: Available online 22 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Guus A. Westerhof, Hanneke Coumou, Selma B. de Nijs, ElsJ. Weersink, Elizabeth H. Bel
BackgroundAdult-onset asthma is an important but relatively understudied asthma phenotype and little is known about its natural course and prognosis. The remission rate is believed to be low, and it is still obscure which factors predict remission or persistence of the disease.ObjectiveTo determine the remission rate, and identify predictors of persistence and remission of adult-onset asthma.MethodsTwo hundred adult patients with recently diagnosed (<1 year) asthma were recruited from secondary and tertiary pulmonary clinics and prospectively followed for 5 years. Clinical, functional and inflammatory parameters were assessed at baseline and at yearly visits. Asthma remission was defined as absence of asthma symptoms for ≥1 year and no asthma medication use for ≥1 year. Descriptive statistics and logistic regression analysis were performed.ResultsFive-year follow-up data of 170 patients (85%) was available. Of these, 27 patients (15.9%) experienced asthma remission. Patients with asthma persistence were older, had worse asthma control, required higher doses of inhaled corticosteroids, had more severe airway hyperresponsiveness, more often nasal polyps and higher levels of blood neutrophils as compared to patients who experienced clinical remission.In a multivariable logistic regression analysis, only moderate-severe bronchial hyperresponsiveness and nasal polyps were independent predictors of asthma persistence. Patients with these two characteristics had less than 1% chance of asthma remission.ConclusionOne in six patients with adult-onset asthma experiences remission within the first 5 years of the disease. In patients with moderate to severe bronchial hyperresponsiveness and nasal polyposis the chance of remission is close to zero.

Teaser

Adult-onset asthma remission occurs in 16% of the patients within 5 years after diagnosis. Nasal polyposis and moderate to severe bronchial hyperresponsiveness at the time of asthma diagnosis reduces the chance of remission to <1%.


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