Adult asthma persisting from childhood asthma: a novel phenotype of severe asthma

Published online: January 22, 2020

Approximately 30% of individuals with childhood asthma have asthma that persists in their adult years. This population comprises a rather large number of patients. Adult patients whose asthma persisted from childhood have a longer duration of asthma, which is a risk factor for poor asthma control and airway remodeling induced by persistent airway inflammation. Adult asthma that has persisted from childhood asthma is thus potentially difficult to treat and seemed to be a distinct clinical phenotype. However, the clinical characteristics of adult patients with asthma that has persisted from childhood are not well documented.

To test the hypothesis that adult asthma persisting form childhood asthma represents a distinct phenotype, To et al. carried out a large study involving 1443 patients with asthma, which was recently published in The Journal of Allergy and Clinical Immunology: In Practice. The main aim of this study was to determine the clinical characteristics of adult patients with persistent asthma since childhood. The researchers evaluated patients diagnosed with asthma who visited the researchers’ hospital. Subjects were classified into 3 groups: those with adult-onset asthma (adult-onset group), those who had remitted from childhood asthma but then relapsed in adulthood (relapsed group), and those with persistent asthma from childhood (persistent group). The clinical characteristics of the groups were compared.

The persistent group had lower forced expiratory flow at 75% of vital capacity (%FEF75) values compared to the adult-onset and relapsed groups. Forced expiratory volume in 1 second (%FEV1) and forced expiratory flow at 50% of vital capacity (%FEF50) values were lower in the persistent group than in the adult-onset group. The proportion of patients with severe asthma in the persistent groups was highest among the three groups (31% in the adult-onset group, 34% in the relapsed group, and 40% in the persistent group; p=0.015). A multivariable logistic regression analysis (dependent variable: severe asthma) in each group revealed that the factors associated with severe asthma differed among the adult-onset, relapsed, and persistent groups.

In summary, adult patients with asthma that has persisted from childhood have poorer lung function and more severe asthma in adulthood than those with adult-onset asthma. The findings highlight that asthma which persists from childhood to adulthood presents a distinct clinical phenotype that may require a different management approach than used for other adults with asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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