Published Online: June 24, 2014
New-onset asthma in adults is a heterogeneous disorder that ranges from mild to very severe. Several cross-sectional studies have described clinical characteristics of patients with adult-onset asthma. However, it is currently unknown which patients are prone to developing severe cases of the disease.
In a prospective cohort study recently published in The Journal of Allergy and Clinical Immunology, Westerhof and colleagues analyzed data from 200 adult patients with newly diagnosed asthma. These patients underwent an extensive diagnostic assessment at baseline, including medical history, symptom questionnaires, comorbidities, medication use, and lung function, as well as markers of airway inflammation such as inflammatory cells in blood and sputum, and the level of nitric oxide in exhaled breath. After two years, patients were reassessed and evaluated for change in asthma severity according to the Global Initiative for Asthma (GINA) severity score, a score based on symptom control, medication use and lung function.
Almost one seventh of patients showed an increase in asthma severity after two years. The authors report the only risk factor for this rapid increase in asthma severity was a history of smoking. Every pack of cigarettes smoked in the past increased the risk of developing more severe asthma. These findings imply that adults with new onset asthma who have smoked in the past should be closely monitored and receive early therapeutic intervention. Since inhaled corticosteroids are not very effective in these patients, novel targeted therapies need to be developed for this highly prevalent category of patients.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.