Adult Asthma That Has Persisted From Childhood May Represent New Phenotype

Adults with asthma that has persisted from their childhood to adulthood have poorer lung function and more severe disease in adulthood compared with individuals who have adult-onset asthma, according to results from a cross-sectional study published in the Journal of Allergy and Clinical Immunology: In Practice.¹

Recognizing that in approximately 30% of children with asthma, the disorder persists into adulthood,^2-5 investigators sought to compare the clinical characteristics among 3 distinct groups of patients: those with adult-onset asthma (the adult-onset group), those who had remitted childhood asthma that relapsed (the relapsed group), and those who had asthma that had persisted since childhood (the persistent group).

A total of 1443 participants (≥18 years of age) were enrolled. Patients in the persistent group were younger and included fewer individuals who had a history of smoking. Moreover, the persistent group had more men included compared with the other 2 groups. Statistically significant differences were observed among the 3 groups with respect to the following: age, sex, the percentages of patients with a family history of asthma, smoking history, and the percentages of patients with comorbidities of allergic rhinitis and atopic dermatitis.

The percentage of patients with a family history of asthma was significantly higher in patients in the persistent group compared with those in the adult-onset or relapsed groups (P <.001). Furthermore, the rates of allergic rhinitis and atopic dermatitis were significantly higher in patients in the persistent group than in those in the adult-onset group (P <.001 for both comorbidities).

The percentage of patients with severe asthma differed among those in the 3 groups, at 31% in the adult-onset group, 34% in the relapsed group, and 40% in the persistent group (P =.015). Moreover, the percentage of patients with severe asthma in the persistent group was significantly higher than that in the adult-onset group (P =.005), but not statistically higher than that in the relapsed group (P =.238). No significant differences in the percentage of patients with severe asthma were observed between patients in the relapsed group and those in the adult-onset group (P =.499). In addition, the forced expiratory flow at 75% of vital capacity values were lower in the persistent group than in the relapsed or the adult-onset groups.

Major limitations of the study included the fact that because of the cross-sectional design, data regarding the treatment or control of asthma in childhood could not be collected. Nevertheless, the treatment and control of asthma in childhood might have affected the severity of an individual’s asthma in adulthood. Also, as the study was conducted at a specialist hospital, no patients were enrolled who had received treatment at a primary care clinic.

“Asthma that persists from childhood to adulthood seems to present a distinct clinical phenotype of adult asthma, and this should be considered when clinicians attempt to optimize treatment for their adult patients with asthma,” the researchers concluded.

References

1. To M, Tsuzuki R, Katsube O, et al. Persistent asthma from childhood to adulthood presents a distinct phenotype of adult asthma [published online January 22, 2020]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2020.01.011

2. Rackemann FM, Edwards MC. Asthma in children — a follow-up study of 688 patients after an interval of twenty years. N Engl J Med. 1952;246(21):815-823.

3. Phelan PD, Robertson CF, Olinsky A. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol. 2002;109(2):189-194.

4. Maruo H, Hashimoto K, Shimoda K, et al. [Long-term follow-up studies of bronchial asthma in children. I. Prognosis and risk factors]. Arerugi. 1990;39(7):621-630. [Article in Japanese]

5. Zeiger RS, Dawson C, Weiss S. Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP). J Allergy Clin Immunol. 1999;103(3 pt 1):376-387.