Disclosures: Toppila-Salmi reports receiving grants from GlaxoSmithKline and consults for AstraZeneca, ERT, Novartis, Sanofi Pharma and Roche. Please see the study for all other authors’ relevant financial disclosures.
July 30, 2021
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Smoking, NSAID-exacerbated respiratory disease risk factors for severe adult-onset asthma

Disclosures: Toppila-Salmi reports receiving grants from GlaxoSmithKline and consults for AstraZeneca, ERT, Novartis, Sanofi Pharma and Roche. Please see the study for all other authors’ relevant financial disclosures.
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A new study published in BMC Pulmonary Medicine identified independent risk factors for severe adult-onset asthma, including smoking, NSAID-exacerbated respiratory disease, male sex and two or more siblings.

“Early detection of the risk factors contributing to severe adult-onset asthma is important to decrease morbidity and costs,” Sanna Toppila-Salmi, MD, PhD, researcher in the department of pathology at Haartman Institute at the University of Helsinki, Haartmanikatu, and the Skin and Allergy Hospital at the Hospital District of Helsinkin and Uusimaa at Helsinki University Hospital and the University of Helsinki, Finland, and colleagues wrote. “Most previous results have focused on one or a few risk factors, although the phenotypes of asthma are multifactorial.”

Independent risk factors for severe asthma
Data were derived from Toppila-Salmi S, et al. BMC Pulm Med. 2021;doi:10.1186/s12890-021-01578-4.

The cross-sectional, population-based, case-controlled study used data from Finnish national registries to aggregate a sample of 1,350 patients with adult-onset asthma (mean age, 54.4 years; 62.1% women). Severe asthma was defined as self-reported severe asthma and symptoms, at least one oral corticosteroid course per year or regular oral corticosteroid use and sleep disruption due to symptoms or wheezing a few times per month.

Researchers selected 16 covariates that included personal characteristics, education, lifestyle, early-life factors, asthma characteristics and multiple morbidities to assess associations with severe asthma.

One hundred (7.4%) patients had severe asthma.

Severe asthma was significantly associated with male sex (OR = 2.12; 95% CI, 1.41-3.2), age (OR = 1.03; 95% CI, 1.02-1.05), low education level (OR = 0.5; 95% CI, 0.31-0.82), no professional training (OR = 0.51; 95% CI, 0.33-0.8), smoking (OR = 2.1; 95% CI, 1.32-3.32), having two or more siblings (OR = 2.66; 95% CI, 1.37-5.2), one or more comorbidity (OR = 2.97; 95% CI, 1.67-5.28) and NSAID-exacerbated respiratory disease (NERD; OR = 2.13; 95% CI, 1.25-3.63) in a univariate analysis (P < .05). The researchers also reported a trend for association between severe asthma and severe childhood infection, presence of chronic rhinosinusitis with nasal polyps and being the first-born child (P < .02).

In a multivariate model, severe asthma was significantly associated with male sex (OR = 1.96; 95% CI, 1.16-3.3), smoking (OR = 1.98; 95% CI, 1.11-3.52), comorbidities (OR = 2.68; 95% CI 1.35-5.31), NERD (OR = 3.29; 95% CI, 1.75-6.19) and having two or more siblings (OR = 2.51; 95% CI, 1.17-5.41). In addition, researchers observed a dose-response effect of all these risk factors on severe asthma (OR = 2.3; 95% CI, 1.81-2.93) for each additional unit increase (P < .001).

“Although these results need validation in other populations, in terms of clinical implications, they reinforce the need for smoking cessation and the importance of diagnostics and the management of NERD and other comorbidities to prevent severe asthma in adult-onset asthma patients,” the researchers wrote.