Late-diagnosed asthma was identified as the most significant independent risk factor for non-remission in patients with asthma, according to study results published in The Journal of Allergy and Clinical Immunology: In Practice.
Researchers sought to determine the correlation between asthma remission, age, and sex, and identify risk factors of non-remission. They conducted an analysis using data from a 2016 FinEsS (Finland, Estonia, Sweden) questionnaire. The study included 16,000 patients between the ages of 20 and 69 years from Helsinki and Western Finland. The individuals were then categorized based on stage of diagnosis: early (0-11 years) intermediate (12-39 years) and late (40-69 years). Additional covariates such as body mass index (BMI), age, sex, and presence of allergic rhinitis or chronic obstructive pulmonary disease (COPD), were also identified among the patients as well as living in a rural area or on a farm during childhood, family history, smoking, and exercise. Remission was then evaluated in 10-year segments.
A total of 8199 (51.5%) patients responded to the questionnaire and 7930 remained after excluding those with incomplete smoking data (n=269). Of those 7930 individuals, 879 (11.1%) presented with physician-diagnosed asthma and 162 (18.4%) reported asthma in remission. Researchers identified remission in early-diagnosed asthma (30.2%) as the most common, followed by intermediate-diagnosed asthma (17.9%), and late-diagnosed asthma (5.0%; P <.001) as the least common.
Median time from diagnosis was determined at 27, 18.5, and 10 years, and remission rates corresponded respectively between men (36.7%, 20.0%, and 3.4%) and women (20.4%, 16.6%, and 5.9%; sex difference P <.001). Individuals who reported early-diagnosed asthma were most often men, with the lowest BMI, and highest presence of allergic rhinitis. Individuals with late-diagnosed asthma, however, were mostly women, with the highest BMI, and only a third had allergic rhinitis.
The researchers further identified risk factors of asthma non-remission in adult-diagnosed asthma (12-69 years; odds ratio [OR], 2.97; 95% CI, 2.06-4.27) in both intermediate-diagnosed (OR, 1.99; 95% CI, 1.35-2.92) and late-diagnosed (OR, 8.19; 95% CI, 4.31-15.55; all P <.001) asthma. A greater risk for non-remission was identified by age at asthma diagnosis (OR, 1.45; P <.001 per 10 year increase) compared to a patient’s current age (OR, 1.20; P =.001 per 10-year increase) or time from diagnosis (OR, 1.33; P <.001 per 10-year decrease). Additionally, sex differences in asthma remission (P =.001) were reported between men (23.6%) and women (14.5%). Among the different groups, men with early-diagnosed asthma were found to be more frequently in remission (P <.006).
Although there are inherent limitations in retrospective studies, Finland’s process of collecting patient records mitigated the limitations that may have affected the study. Therefore, the researchers determined the data presented to be precise and accurate.
A patient’s age at asthma diagnosis was determined a reliable predictor of asthma remission, although adult-diagnosed asthma was seldom in remission. The researchers concluded that “to affect prognosis of asthma, follow-up resources should be increased in adult-onset asthma, and follow-up needs to be intensified especially in patients whose asthma has occurred after 30 years of age as they have highest risk of non-remittance.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Honkamäki J, Piirilä P, Hisinger-Mölkänen H, et al. Asthma remission by age at diagnosis and gender in a population-based study. J Allergy Clin Immunol Pract. Published online December 14, 2020. doi:10.1016/j.jaip.2020.12.015