Age 40 the watershed for addressing asthma exacerbation burden
15/08/2022
Age 40 the watershed for
addressing asthma exacerbation burden
By Nicola
Garrett (courtesy of The Limbic)
5
Aug 2022
Asthma
exacerbations are associated with faster lung function decline, particularly in
younger patients, the largest study of its kind confirms.
The findings
highlight the “potential value” of addressing
exacerbation burden when patients are still in the growth and plateau phases of
lung trajectory before 40 years of age, the UK researchers say.
The
study involved over 100,000 asthma patients from the Optimum Patient Care
Research Database who were followed for up to 60 years and had more than three
eligible post-18th birthday peak expiratory flow (PEF) rate or forced
expiratory flow in 1 second (FEV₁) records.
The
research team found that the greater the annual exacerbation rate, the lower
the starting lung function and the more negative the trajectory over time.
After
adjusting for confounders, for each additional exacerbation an estimated
additional −1.34 L/min PEF per year were lost. Patients with annual
exacerbation rates (AERs) >2/year and aged 18–24 years at baseline lost an
additional −5.95 L/min PEF/ year compared with those who had no exacerbations.
“This association and speed of lung function
decline were stronger in younger patients aged 18–39 years, persisted even in
patients on higher average daily inhaled corticosteroid doses and was
consistent for trajectories based on either PEF or FEV1,” the study authors
wrote in their paper published in Thorax.
The
fact that the greatest association of exacerbations was seen in younger
patients with lung function in the plateau or start of decline phase had
important implications for earlier therapeutic intervention, they said.
“This
finding underlines the need for a review of the management of patients at risk
of accelerated decline before reaching 40 years of age; patients with fastest
decline tended to already be on the highest Global Initiative for Asthma (GINA)
therapies (ie, GINA 3+), suggesting that many may be less responsive to ICS or
to OCS, the long-term use of which are associated with significant negative
side effects in asthma and COPD,” they wrote.
They
noted that while biologics were currently only indicated for subgroups of
patients with severe asthma, their findings suggested that patients with
frequent exacerbations might also benefit from earlier targeted therapy as well
as lifestyle interventions.
While the study demonstrated a clear link between
exacerbations and lung function decline, there was a need for studies to fully
quantify the chronology of the relationship and assess causality, they
added.