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Early and Late Onsets of Severe Asthma are Associated with Divergent Phenotypes of the Disease
PDPI Malang, 10 Apr 2019 02:34:13


Background: Asthma is now recognized as a heterogeneous disease. Several phenotypes of asthma have been characterized, leading to a better understanding of the disease and to personalize heath cares.

Aims: Because early-onset of asthma is believed to be linked to allergic disease than late-onset of asthma, the aim of the study was to compare characteristics of severe asthma, according to age of onset of the disease.

Methods: Based on ERS/ATS definitions, 225 patients with severe asthma were retrospectively included in the study. Clinical, biological, functional and CT scan characteristics were collected. Early- and late-onset of asthma were defined as an onset of the disease before and after 18 years old respectively.

Results: A late-onset of asthma was recognized for 133 patients and asthma started during childhood for 92 patients. In univariate analysis, subjects with early-onset of the disease were younger (p<0.0001), duration of illness was longer (p < 0.0001). Asthmatics with early-onset of the disease had higher prevalence of positive skin tests (0.024) and have more often familial atopy (p = 0.006). By contrast, subjects with late-onset of asthma had more frequently nasal polyps (p = 0.008), obesity (p = 0.035), demonstrated a higher peripheral blood eosinophilia (p = 0.023), a lower FEV1/CVF (0.011) and an increase of bronchial wall thickening (0.027) on HR-CT scan.

Conclusions: Early-onset of asthma is more linked to atopy and late-onset of the disease is associated to more frequent blood eosinophilia, findings suggesting bronchial remodeling and more comorbidity. Overall data suggest that the onset of the disease is an efficient tool to characterize phenotypes of asthma.

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