Longer asthma duration associated with asthma persistence
Published online: April 1, 2021
Asthma is a disease affecting millions worldwide, a large percentage being adults. Numerous studies have shown that asthma remission in adults is very low. Yet, there is not a clear consensus on when asthma exactly is in remission. Furthermore, we know little about who experiences remission of the disease. Additionally, the long-term disease trajectory, in terms of severity, is very sparsely explored.
One hundred twenty-five adults diagnosed with asthma over 30 years ago were thoroughly examined at a follow-up visit, with their current asthma status clarified. The results of this follow-up study are published in The Journal of Allergy and Clinical Immunology: in Practice, in a paper by Tupper et al.
The participants' current asthma status was assessed by questionnaires, pulmonary function testing, including assessment of reversibility and airway responsiveness, and blood biomarker measurements. Based on these assessments, participants were classified as having either active asthma, clinical remission (not experiencing symptoms or using asthma medication) or complete remission (the former together with absence of objective disease activity). The long-term disease severity trajectory was determined based on changes in participants’ symptom control and currently prescribed asthma inhaler medication.
The study found that 15 % of participants had neither symptoms, medication use, nor had measurable signs of asthma activity. Longer symptom duration before the initial diagnosis was associated with a higher chance of manifesting signs of active asthma. Additionally, participants with lower lung function were also at higher risk of still having active asthma at follow-up after 30 years. While disease severity appeared mostly unchanged in terms of the average amount of asthma medication taken by participants, the observation that about two-thirds did not have well-controlled disease made it challenging to determine the actual severity. Females, patients with a previous asthma flare-up, or those who were older were more likely to have more severe disease at follow-up. The finding of symptom duration being associated with asthma persistence raises the question of whether, with earlier follow-up and proper treatment, the disease trajectory could be altered
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.