Azim Adnan, Freeman Anna, Lavenu Audrey, Mistry Heena, Haitchi Hans Michael, Newell Colin, Cheng Yueqing, Thirlwall Yvette, Harvey Matthew, Barber Clair, Pontoppidan Katarina, Dennison Paddy, Arshad S Hasan, Djukanovic Ratko, Howarth Peter, Kurukulaaratchy Ramesh J
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Faculté de médecine, Université de Rennes 1, Rennes, France; INSERM CIC 1414, Université de Rennes 1, Rennes, France; IRMAR, Institut de Recherche Mathématique de Rennes, UMR CNRS 6625, Rennes, France.
J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3396-3406.e4. doi: 10.1016/j.jaip.2020.05.053. Epub 2020 Jun 13.
Asthma is a diverse condition that differs with age and sex. However, it remains unclear how sex, age of asthma onset, and/or their interaction influence clinical expression of more problematic adult "difficult" asthma.
To better understand the clinical features of difficult asthma within a real-world clinical setting using novel phenotypic classification, stratifying subjects by sex and age of asthma onset.
Participants in a longitudinal difficult asthma clinical cohort study (Wessex AsThma CoHort of difficult asthma; WATCH), United Kingdom (n = 501), were stratified into 4 difficult asthma phenotypes based on sex and age of asthma onset (early <18 years or adult ≥18 years) and characterized in relation to clinical and pathophysiological features.
The cohort had more female participants (65%) but had similar proportions of participants with early- or adult-onset disease. Early-onset female disease was commonest (35%), highly atopic, with good spirometry and strong associations with some physical comorbidities but highest psychophysiologic comorbidities. Adult-onset females also had considerable psychophysiologic comorbidities and highest obesity, and were least atopic. Amongst male subjects, proportionately more had adult-onset disease. Early-onset male disease was rarest (14%) but associated with worst lung function, high smoking, atopy, and fungal sensitization. Despite shortest disease duration, adult-onset males had highest use of maintenance oral corticosteroid, poor lung function, and highest fractional exhaled nitrogen oxide in spite of highest smoking prevalence.
This study shows that sex, age of asthma onset, and their interactions influence different clinical manifestations of difficult asthma and identifies a greater risk for lung function loss and oral corticosteroid dependence associated with smoking in adult-onset male subjects.
哮喘是一种因年龄和性别而异的复杂病症。然而，性别、哮喘发病年龄和/或它们之间的相互作用如何影响更具问题的成人“难治性”哮喘的临床表现仍不清楚。
使用新的表型分类，在真实世界的临床环境中更好地了解难治性哮喘的临床特征，按哮喘发病的性别和年龄对受试者进行分层。
英国一项纵向难治性哮喘临床队列研究（韦塞克斯难治性哮喘队列研究；WATCH）的参与者（n = 501），根据哮喘发病的性别和年龄（早发<18岁或成人≥18岁）被分为4种难治性哮喘表型，并对其临床和病理生理特征进行了描述。
该队列中女性参与者更多（65%），但早发或成人发病疾病的参与者比例相似。早发性女性疾病最为常见（35%），具有高度特应性，肺功能良好，与一些躯体合并症有很强的关联，但心理生理合并症最为严重。成人发病的女性也有相当多的心理生理合并症和最高的肥胖率，且特应性最低。在男性受试者中，成人发病疾病的比例相对更高。早发性男性疾病最为罕见（14%），但与最差的肺功能、高吸烟率、特应性和真菌致敏相关。尽管病程最短，但成人发病的男性使用维持性口服皮质类固醇的比例最高，肺功能差，呼出一氧化氮分数最高，尽管吸烟率最高。
本研究表明，性别、哮喘发病年龄及其相互作用会影响难治性哮喘的不同临床表现，并确定成人发病男性受试者中与吸烟相关的肺功能丧失和口服皮质类固醇依赖风险更高。
