Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
J Allergy Clin Immunol Pract. 2022 Jul;10(7):1825-1834.e8. doi: 10.1016/j.jaip.2022.03.019. Epub 2022 Apr 8.
Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood.
To investigate differences in patients' characteristics by age at asthma onset.
From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18-40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (OR) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model.
In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (OR 1.4; 95% CI 1.1-1.8) and lower risks for atopic disorders (OR 0.8; 95% CI 0.7-0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (OR 1.8; 95% CI 1.2-2.6), overweight/obesity (OR 1.3; 95% CI 1.2-1.4), gastroesophageal reflux disease (OR 1.4; 95% CI 1.2-1.7), and diabetes (OR 2.3; 95% CI 1.8-2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (OR 2.8; 95% CI 1.7-4.5).
This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.
哮喘可发生于任何年龄，但儿童期、成年期和晚发性哮喘患者的特征差异尚不清楚。
通过发病年龄来研究患者特征的差异。
我们从 5 个欧洲电子数据库中创建了一个队列，纳入了 2008 年至 2013 年期间被医生诊断为哮喘的成年患者。根据发病年龄将患者分为儿童期发病（发病年龄<18 岁）、成年期发病（发病年龄 18-40 岁）和晚发性哮喘（发病年龄≥40 岁）。在研究入组时评估合并症。对于每个特征和合并症，我们根据每个数据库估计比较哮喘发病类别的比值比和年龄及性别调整比值比（OR），并使用随机效应模型进行荟萃分析。
共纳入 586436 例成年哮喘患者，81691 例为儿童期发病，218184 例为成年期发病，286561 例为晚发性哮喘。总体而言，7.3%的患者为重度哮喘。与儿童期哮喘相比，成年期发病患者超重/肥胖的风险更高（OR 1.4；95% CI 1.1-1.8），而特应性疾病的风险更低（OR 0.8；95% CI 0.7-0.95）。与成年期发病相比，晚发性哮喘患者发生鼻息肉（OR 1.8；95% CI 1.2-2.6）、超重/肥胖（OR 1.3；95% CI 1.2-1.4）、胃食管反流病（OR 1.4；95% CI 1.2-1.7）和糖尿病（OR 2.3；95% CI 1.8-2.9）的风险更高。晚发性哮喘与未控制哮喘之间存在显著相关性（OR 2.8；95% CI 1.7-4.5）。
这项国际研究表明，在成年患者中，儿童期、成年期和晚发性哮喘表型的合并症存在明显差异。此外，晚发性哮喘患者未控制哮喘更为常见。
