Asthma

Age 40 the watershed for addressing asthma exacerbation burden 


Asthma exacerbations are associated with faster lung function decline, particularly in younger patients, the largest study of its kind confirms.

The findings highlight the “potential value” of addressing exacerbation burden when patients are still in the growth and plateau phases of lung trajectory before 40 years of age, the UK researchers say. 

The study involved over 100,000 asthma patients from the Optimum Patient Care Research Database who were followed for up to 60 years and had more than three eligible post-18th birthday peak expiratory flow (PEF) rate or forced expiratory flow in 1 second (FEV₁) records. 

The research team found that the greater the annual exacerbation rate, the lower the starting lung function and the more negative the trajectory over time.

After adjusting for confounders, for each additional exacerbation an estimated additional −1.34 L/min PEF per year were lost. Patients with annual exacerbation rates (AERs) >2/year and aged 18–24 years at baseline lost an additional −5.95 L/min PEF/ year compared with those who had no exacerbations. 

“This association and speed of lung function decline were stronger in younger patients aged 18–39 years, persisted even in patients on higher average daily inhaled corticosteroid doses and was consistent for trajectories based on either PEF or FEV1,” the study authors wrote in their paper published in Thorax. 

The fact that the greatest association of exacerbations was seen in younger patients with lung function in the plateau or start of decline phase had important implications for earlier therapeutic intervention, they said. 

“This finding underlines the need for a review of the management of patients at risk of accelerated decline before reaching 40 years of age; patients with fastest decline tended to already be on the highest Global Initiative for Asthma (GINA) therapies (ie, GINA 3+), suggesting that many may be less responsive to ICS or to OCS, the long-term use of which are associated with significant negative side effects in asthma and COPD,” they wrote. 

They noted that while biologics were currently only indicated for subgroups of patients with severe asthma, their findings suggested that patients with frequent exacerbations might also benefit from earlier targeted therapy as well as lifestyle interventions.  

While the study demonstrated a clear link between exacerbations and lung function decline, there was a need for studies to fully quantify the chronology of the relationship and assess causality, they added. 

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