Wenjia Chen1, J Mark FitzGerald2, Larry D Lynd3, Don D Sin4, Mohsen Sadatsafavi5. 1. Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. 2. Institute for Heart and Lung Health, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada. 3. Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health, St Paul's Hospital, Vancouver, BC, Canada. 4. Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, The UBC Centre for Heart Lung Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 5. Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada. Electronic address: msafavi@mail.ubc.ca.
Abstract
BACKGROUND: Most patients with asthma have mild disease. However, the clinical course of mild asthma and risk factors for progression are not well studied. OBJECTIVE: To examine the long-term trajectories of mild asthma and the effects of early-stage risk factors on the subsequent disease course. METHODS: From the administrative health data of British Columbia, Canada, we identified patients aged 14 to 45 years with newly diagnosed mild asthma between January 1997 and December 2012. For each follow-up year, we categorized a patient's asthma severity into mild/dormant, moderate, or severe on the basis of the intensity of asthma medications and occurrence of exacerbations. Ordinal logistic regression was used to estimate the probability of severity or all-cause death in the next year as a function of a patient's severity history in the past 3 years and selected baseline risk factors. RESULTS: The study included 70,829 patients with incident mild asthma (62% women; mean age, 31 years). Over 10 years, 8% of these patients transitioned to moderate or severe asthma. Inappropriate use of rescue medications and older age were the most influential determinants for progression from mild asthma (odds ratios, 1.79; 95% CI, 1.68-1.90; P < .001; 1.24 per 10-year increase in age; 95% CI, 1.22-1.27; P < .001), whereas the presence of allergic rhinitis had no significant effects (odds ratio, 0.95; 95% CI, 0.91-1.00; P = .063). CONCLUSIONS: Mild asthma remains largely stable over time. However, potentially modifiable factors such as inappropriate use of rescue medications are associated with a worsened prognosis.
BACKGROUND: Most patients with asthma have mild disease. However, the clinical course of mild asthma and risk factors for progression are not well studied. OBJECTIVE: To examine the long-term trajectories of mild asthma and the effects of early-stage risk factors on the subsequent disease course. METHODS: From the administrative health data of British Columbia, Canada, we identified patients aged 14 to 45 years with newly diagnosed mild asthma between January 1997 and December 2012. For each follow-up year, we categorized a patient's asthma severity into mild/dormant, moderate, or severe on the basis of the intensity of asthma medications and occurrence of exacerbations. Ordinal logistic regression was used to estimate the probability of severity or all-cause death in the next year as a function of a patient's severity history in the past 3 years and selected baseline risk factors. RESULTS: The study included 70,829 patients with incident mild asthma (62% women; mean age, 31 years). Over 10 years, 8% of these patients transitioned to moderate or severe asthma. Inappropriate use of rescue medications and older age were the most influential determinants for progression from mild asthma (odds ratios, 1.79; 95% CI, 1.68-1.90; P < .001; 1.24 per 10-year increase in age; 95% CI, 1.22-1.27; P < .001), whereas the presence of allergic rhinitis had no significant effects (odds ratio, 0.95; 95% CI, 0.91-1.00; P = .063). CONCLUSIONS: Mild asthma remains largely stable over time. However, potentially modifiable factors such as inappropriate use of rescue medications are associated with a worsened prognosis.
Authors: Erick Forno; Diego D Brandenburg; Jose A Castro-Rodriguez; Carlos A Celis-Preciado; Fernando Holguin; Christopher Licskai; Stephanie Lovinsky-Desir; Marcia Pizzichini; Alejandro Teper; Connie Yang; Juan C Celedón Journal: Ann Am Thorac Soc Date: 2022-04
Authors: Alan Kaplan; Patrick D Mitchell; Andrew J Cave; Remi Gagnon; Vanessa Foran; Anne K Ellis Journal: J Clin Med Date: 2020-03-27 Impact factor: 4.241