Turrin Martina, Rizzo Michele, Bonato Matteo, Bazzan Erica, Cosio Manuel G, Semenzato Umberto, Saetta Marina, Baraldo Simonetta
Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova and Padova City Hospital, Padova, Italy.
Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova and Padova City Hospital, Padova, Italy; Meakins-Christie Laboratories and Respiratory Division, McGill University, Montreal, Québec, Canada.
J Allergy Clin Immunol Pract. 2022 Dec;10(12):3196-3203. doi: 10.1016/j.jaip.2022.08.007. Epub 2022 Aug 12.
Asthma can present in early childhood or de novo in adulthood. Our understanding of the burden of comorbidities in adult asthmatic patients stratified by age at onset is incomplete.
To evaluate how different comorbidities may affect symptom control in two distinct groups of patients with early- and late-onset asthma (EOA and LOA, respectively) and to explore whether reported comorbidities are associated with lung function and inflammatory parameters.
We conducted a cross-sectional study of 175 adult asthmatic patients (aged 57.5 ± 17.1 years) recruited at our university asthma clinic. We defined EOA as asthma onset less than 12 years, and LOA as onset greater than 40 years. The primary outcome was symptom control and main comorbidities evaluated were rhinitis, gastroesophageal reflux, obesity, cardiovascular conditions, and bronchiectasis. We used multivariable regression analysis to identify potential predictors of poor control in EOA and LOA.
Of 175 subjects, 77 had EOA (44%), 98 had LOA (56%), and comorbidities had a differential impact in the two groups. Rhinitis was more frequent in EOA (76 vs 53%; P = .02) and was associated with uncontrolled asthma (P < .001), reduced FEV/FVC (P = .01), increased eosinophils (P = .003) and total IgE (P < .01). Conversely, in LOA, rhinitis was associated with more controlled asthma and higher FEV/FVC (both P < .01). In EOA, only, IgE levels were directly related to blood eosinophils (r = 0.42; P <.001) and inversely to FEV/FVC (r = -0.35; P = .002). Obesity was present in 20% of patients in both groups, but only in LOA was it associated with uncontrolled disease (P = .009), reduced FEV/FVC (P = .009), and blood neutrophils (P = .03). In multivariable regression analysis, rhinitis in EOA and obesity in LOA were the risk factors most closely associated with poor control. Gastroesophageal reflux, cardiovascular comorbidities, and bronchiectasis did not affect control.
Early-onset persistent asthma and late-onset asthma are distinct phenotypes with different underlying inflammatory patterns and different comorbidities affecting symptom control.
哮喘可在儿童早期出现，也可在成年期新发。我们对按发病年龄分层的成年哮喘患者合并症负担的了解并不完整。
评估不同合并症如何影响两组分别为早发型和晚发型哮喘（分别为EOA和LOA）患者的症状控制，并探讨所报告的合并症是否与肺功能和炎症参数相关。
我们对在我校哮喘诊所招募的175例成年哮喘患者（年龄57.5±17.1岁）进行了一项横断面研究。我们将EOA定义为哮喘发病年龄小于12岁，将LOA定义为发病年龄大于40岁。主要结局是症状控制，评估的主要合并症为鼻炎、胃食管反流、肥胖、心血管疾病和支气管扩张。我们使用多变量回归分析来确定EOA和LOA中控制不佳的潜在预测因素。
在175名受试者中，77例为EOA（44%），98例为LOA（56%），合并症在两组中的影响不同。鼻炎在EOA中更常见（76%对53%；P = 0.02），且与哮喘控制不佳相关（P < 0.001），FEV/FVC降低（P = 0.01），嗜酸性粒细胞增多（P = 0.003）和总IgE升高（P < 0.01）。相反，在LOA中，鼻炎与哮喘控制更好和FEV/FVC更高相关（均P < 0.01）。仅在EOA中，IgE水平与血液嗜酸性粒细胞直接相关（r = 0.42；P < 0.001），与FEV/FVC呈负相关（r = -0.35；P = 0.002）。两组中20%的患者存在肥胖，但仅在LOA中，肥胖与疾病控制不佳相关（P = 0.009），FEV/FVC降低（P = 0.009）和血液中性粒细胞增多（P = 0.03）。在多变量回归分析中，EOA中的鼻炎和LOA中的肥胖是与控制不佳最密切相关的危险因素。胃食管反流、心血管合并症和支气管扩张不影响控制。
早发型持续性哮喘和晚发型哮喘是不同的表型，具有不同的潜在炎症模式和不同的合并症影响症状控制。
