Published online: April 4, 2017
It is recognized that asthma is not a single disease but manifests in many different forms (phenotypes). These phenotypes may have very different long-term prognoses. So far, the characterization of the different phenotypes as well as their long-term prognosis have remained unclear.
In the recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Ilmarinen and colleagues investigated phenotypes of asthma and their 12-year prognosis. The study was part of Finnish Seinäjoki Adult Asthma Study (SAAS) and included 171 patients, who were diagnosed to have asthma starting at adult age. The study cohort included smokers, obese and multi-morbid patients usually excluded from asthma studies. This study had exceptionally long follow-up of patients, starting from diagnosis and ending up in a 12-year follow-up visit. Furthermore, information on healthcare use during the whole follow-up period was also included.
By using cluster analysis, the authors identified five different phenotypes of adult-onset asthma: smoking, obesity-related, female, atopic and non-rhinitic asthma. The poorest outcome was shown in smoking and obesity-related asthma phenotypes. These patients were characterized by highest symptoms, highest use of medication to treat asthma, poorest lung function, poorest disease control and highest use of healthcare. In contrast, atopic/allergic asthma starting at early adulthood had the best prognosis with lowest use of asthma medication, best disease control and infrequent use of healthcare.
This report identifies a different 12-year disease prognosis for smoking, obesity-related, female, atopic and non-rhinitic phenotypes of asthma. Smoking and obesity-related asthma showed the poorest outcome and most unmet needs in their therapy, suggesting the need for special guidance and development of novel treatments. The presented information on long-term outcome of asthma phenotypes can be used to inform clinicians and motivate patients.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.