Phenotyping asthma with airflow obstruction in middle-aged and older adults: a CADSET clinical research collaboration

TY - JOUR

T1 - Phenotyping asthma with airflow obstruction in middle-aged and older adults

T2 - a CADSET clinical research collaboration

AU - Bertels, Xander

AU - Edris, Ahmed

AU - Garcia-Aymerich, Judith

AU - Faner, Rosa

AU - Meteran, Howraman

AU - Sigsgaard, Torben

AU - Alter, Peter

AU - Vogelmeier, Claus

AU - Olvera, Nuria

AU - Kermani, Nazanin Zounemat

AU - Agusti, Alvar

AU - Donaldson, Gavin C

AU - Wedzicha, Jadwiga A

AU - Brusselle, Guy G

AU - Backman, Helena

AU - Rönmark, Eva

AU - Lindberg, Anne

AU - Vonk, Judith M

AU - Chung, Kian Fan

AU - Adcock, Ian M

AU - van den Berge, Maarten

AU - Lahousse, Lies

PY - 2023/8

Y1 - 2023/8

N2 - Background The prevalence and clinical profile of asthma with airflow obstruction (AO) remain uncertain. We aimed to phenotype AO in population- and clinic-based cohorts. Methods This cross-sectional multicohort study included adults ≥50 years from nine CADSET cohorts with spirometry data (N=69 789). AO was defined as ever diagnosed asthma with pre-BD or post-BD FEV 1/FVC <0.7 in population-based and clinic-based cohorts, respectively. Clinical characteristics and comorbidities of AO were compared with asthma without airflow obstruction (asthma-only) and chronic obstructive pulmonary disease (COPD) without asthma history (COPD-only). ORs for comorbidities adjusted for age, sex, smoking status and body mass index (BMI) were meta-analysed using a random effects model. Results The prevalence of AO was 2.1% (95% CI 2.0% to 2.2%) in population-based, 21.1% (95% CI 18.6% to 23.8%) in asthma-based and 16.9% (95% CI 15.8% to 17.9%) in COPD-based cohorts. AO patients had more often clinically relevant dyspnoea (modified Medical Research Council score ≥2) than asthma-only (+14.4 and +14.7 percentage points) and COPD-only (+24.0 and +5.0 percentage points) in population-based and clinic-based cohorts, respectively. AO patients had more often elevated blood eosinophil counts (>300 cells/ µL), although only significant in population-based cohorts. Compared with asthma-only, AO patients were more often men, current smokers, with a lower BMI, had less often obesity and had more often chronic bronchitis. Compared with COPD-only, AO patients were younger, less often current smokers and had less pack-years. In the general population, AO patients had a higher risk of coronary artery disease than asthma-only and COPD-only (OR=2.09 (95% CI 1.26 to 3.47) and OR=1.89 (95% CI 1.10 to 3.24), respectively) and of depression (OR=1.41 (95% CI 1.19 to 1.67)), osteoporosis (OR=2.30 (95% CI 1.43 to 3.72)) and gastro-oesophageal reflux disease (OR=1.68 (95% CI 1.06 to 2.68)) than COPD-only, independent of age, sex, smoking status and BMI.

AB - Background The prevalence and clinical profile of asthma with airflow obstruction (AO) remain uncertain. We aimed to phenotype AO in population- and clinic-based cohorts. Methods This cross-sectional multicohort study included adults ≥50 years from nine CADSET cohorts with spirometry data (N=69 789). AO was defined as ever diagnosed asthma with pre-BD or post-BD FEV 1/FVC <0.7 in population-based and clinic-based cohorts, respectively. Clinical characteristics and comorbidities of AO were compared with asthma without airflow obstruction (asthma-only) and chronic obstructive pulmonary disease (COPD) without asthma history (COPD-only). ORs for comorbidities adjusted for age, sex, smoking status and body mass index (BMI) were meta-analysed using a random effects model. Results The prevalence of AO was 2.1% (95% CI 2.0% to 2.2%) in population-based, 21.1% (95% CI 18.6% to 23.8%) in asthma-based and 16.9% (95% CI 15.8% to 17.9%) in COPD-based cohorts. AO patients had more often clinically relevant dyspnoea (modified Medical Research Council score ≥2) than asthma-only (+14.4 and +14.7 percentage points) and COPD-only (+24.0 and +5.0 percentage points) in population-based and clinic-based cohorts, respectively. AO patients had more often elevated blood eosinophil counts (>300 cells/ µL), although only significant in population-based cohorts. Compared with asthma-only, AO patients were more often men, current smokers, with a lower BMI, had less often obesity and had more often chronic bronchitis. Compared with COPD-only, AO patients were younger, less often current smokers and had less pack-years. In the general population, AO patients had a higher risk of coronary artery disease than asthma-only and COPD-only (OR=2.09 (95% CI 1.26 to 3.47) and OR=1.89 (95% CI 1.10 to 3.24), respectively) and of depression (OR=1.41 (95% CI 1.19 to 1.67)), osteoporosis (OR=2.30 (95% CI 1.43 to 3.72)) and gastro-oesophageal reflux disease (OR=1.68 (95% CI 1.06 to 2.68)) than COPD-only, independent of age, sex, smoking status and BMI.

KW - Male

KW - Humans

KW - Coronary Artery Disease

KW - Cross-Sectional Studies

KW - Asthma/epidemiology

KW - Pulmonary Disease, Chronic Obstructive/epidemiology

KW - Dyspnea

KW - Asthma

KW - COPD epidemiology

KW - Pulmonary Disease

KW - Chronic Obstructive

UR - http://www.scopus.com/inward/record.url?scp=85168566918&partnerID=8YFLogxK

U2 - 10.1136/bmjresp-2023-001760

DO - 10.1136/bmjresp-2023-001760

M3 - Journal article

C2 - 37612099

SN - 2052-4439

VL - 10

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e001760

ER -