Smoking, NSAID-exacerbated Respiratory Disease Among Risk Factors for Severe Asthma Identified in New Study

A new study found several risk factors associated with severe adult-onset asthma, including smoking, NSAID-exacerbated respiratory disease, and sibling count.

A new cross-sectional, population-based, case-controlled study identified independent risk factors for severe adult-onset asthma, including smoking, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD), and male sex.

“Early detection of the risk factors contributing to severe adult-onset asthma is important to decrease morbidity and costs,” wrote authors led by Sanna Toppila-Salmi, MD, PhD, researcher, department of pathology, Haartman Institute, University of Helsinki.“Most previous results have focused on one or a few risk factors, although the phenotypes of asthma are multi-factorial.”

As background for their research, the authors point to the comparatively sparse research on adult-onset asthma and also to the limited knowledge of a common combination of risk factors that lead to development of the severe phenotype.

To further identify these risk factors, researchers used data from Finnish national registries to aggregate a sample of 1350 patients (mean age, 54.4 years; 62.1% women) with adult-onset asthma, of which 100 (7.4%) had severe asthma.

For purposes of the study, severe asthma was defined as self-reported severe asthma and asthma symptoms and regular impairment and ≥1 oral corticosteroid (OCS) course per year or regular OCS use or sleep disruption due to asthma symptoms or wheezing a few times per month.

Researchers selected 16 covariates that included personal characteristics, education, lifestyle, early-life factors, asthma characteristics, and multiple morbidities to assess the associations with severe asthma.

Results

In a univariate analysis, severe asthma was significantly associated with male sex, age, low education level, no professional training, smoking, having ≥2 siblings, having ≥1 chronic comorbidity, and NERD (p<.05).

Researchers also stated there was a trend for an association with severe childhood infection, the presence of chronic rhinosinusitis with nasal polyps, and being the first-born child (p<.2).

In a multivariate regression model, severe asthma was significantly associated with male sex (odds ratio [OR]=1.96; 95% confidence interval [CI], 1.16–3.3), ever smoking (OR=1.98; 95% CI, 1.11–3.52), comorbidities (OR=2.68; 95% CI, 1.35–5.31), NERD (OR=3.29; 95% CI, 1.75–6.19), and having ≥2 siblings (OR=2.51; 95% CI, 1.17–5.41). There was a dose-response effect of all these risk factors on severe asthma (OR=2.3; 95% CI, 1.81–2.93) for each additional unit increase (p<.001), researchers added.

“Although these results need validation in other populations, in terms of clinical implications, they reinforce the need for smoking cessation and the importance of diagnostics and the management of NERD and other comorbidities to prevent severe asthma in adult-onset asthma patients,” researchers concluded.


Reference: Toppila-Salmi S, Lemmetyinen R, Chanoine S, et al. Risk factors for severe adult-onset asthma: a multi-factor approach. BMC Pulm Med. 2021;21:214. doi: 10.1186/s12890-021-01578-4.