Independent risk factors for severe adult-onset asthma include smoking, male sex, comorbidities, having nonsteroidal anti‐inflammatory drug (NSAID)-exacerbated respiratory disease, and having at least 2 siblings, according to a study published in BMC Pulmonary Medicine. Researchers further suggested that these risk factors were cumulative, with each additional risk factor increasing the risk of self-reported asthma.

Early detection of risk factors is crucial for decreasing morbidity and costs associated with severe adult-onset asthma, noted the investigators, who sought to identify the combination of risk factors involved through a population-based, case-control cohort study.

The study used data from Adult Asthma in Finland, a 1997 population-based, matched case-control study of 1350 participants aged 30 years and older (age range, 31-93 years; mean age, 54.4; 62.1% women) with severe asthma. Participants selected for this study had self-reported asthma symptoms or an asthma diagnosis after 15 years of age (mean age at diagnosis, 49.8 years).

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In the final cohort, 100 patients (mean age, 58.7 years) had self-reported severe asthma. Severe asthma was defined as self-reported asthma and symptoms that caused regular impairment and harm along with either the need for at least 1 oral corticosteroid course per year; regular oral corticosteroid use; or waking up during the night due to symptoms a few times a month.

Using literature review findings, the researchers identified 16 covariates — covering personal characteristics, education, lifestyle, early‐life factors, asthma characteristics, and multiple comorbidities — that were evaluated to determine their association with severe asthma.

Through multivariate regression, the researchers identified the risk factors associated with self-reported severe asthma as: male sex (odds ratio [OR], 1.96; 95% CI, 1.16-3.30; P =.011), ever smoking (OR, 1.98; 95% CI, 1.11-3.52; P =.020), chronic comorbidities (OR, 2.68; 95% CI, 1.35-5.31; P=.005), having 2 or more siblings (OR, 2.51; 95% CI, 1.17-5.41; P =.018), and NSAID-exacerbated respiratory disease (OR, 3.29; 95% CI, 1.75-6.19; P <.001).

Moreover, the sum of these 5 identified risk factors was associated with a significant and gradual increase in the risk for severe adult-onset asthma (OR, 2.30; 95% CI, 1.81-2.93; P <.001).

A sensitivity analysis using an oral corticosteroid-based definition for severe asthma further found severe adult-onset asthma to be significantly associated with: ever smoking (OR, 1.69; 95% CI, 1.19-2.40; P =.003), growing up in the countryside/on a farm (OR, 0.69; 95% CI, 0.48-0.99; P =.046), having at least 1 other chronic disease (OR, 1.49; 95% CI, 1.03-2.18; P =.037), and NSAID-exacerbated respiratory disease (OR, 1.68; 95% CI, 1.06-2.69 P =.029).

The researchers said study results “reinforce the need for smoking cessation and the importance of diagnostics and the management of [NSAID-exacerbated respiratory disease] and other comorbidities to prevent severe asthma in adult-onset asthma patients,” also noting that the findings require further validation in additional populations.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Toppila-Salmi S, Lemmetyinen R, Chanoine S, et al. Risk factors for severe adult-onset asthma: a multi-factor approach. BMC Pulm Med. 2021;21(1):214. doi:10.1186/s12890-021-01578-4