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How do sex and age of asthma-onset influence difficult asthma?

Published online: June 13, 2020

Though asthma is common and readily treatable, for a small subset of individuals it is more difficult to control. For these patients, despite treatment with high strength therapies, they continue to suffer from severe life-threatening asthma attacks. Understanding the complex and multifactorial nature of difficult asthma is the first step in making it less difficult to treat.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Azim and Freeman et al describe how age of asthma onset and sex influence the way that difficult asthma manifests within a clinic population. Five hundred and one participants with difficult asthma (Wessex AsThma CoHort of difficult asthma; WATCH), were divided into 4 groups: male early onset, female early onset, male adult onset, female adult onset and compared to each other.

The authors found that the most common group was female early onset disease (35%). These patients typically maintained good lung function but were atopic (allergic) and suffered greatly from anxiety and depression. Females with adult-onset asthma also suffered from anxiety and depression, were more likely to be obese but less likely to be atopic. Most males had adult onset asthma, which was characterized by poor lung function, high levels of fractional exhaled nitric oxide (FeNO – a marker of airway inflammation) and greatest dependence upon regular oral steroid treatment. Males with early onset asthma were uncommon (14%). These patients were usually atopic and more often had fungal sensitivity. They had the highest smoking rates and worst lung function.

Using a simple framework of age of asthma onset and gender, Azim and Freeman et al describe the different ways in which difficult asthma presents: which patients suffer greatest from anxiety and depression, which patients have the worst lung function, and which patients are most dependent upon oral steroids. Characterizing patients in this way can give important insights that guide better identification and management of patients with difficult 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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