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Remission of adult-onset asthma is rare: a 15-year follow-up study

Linnéa Almqvist, Eva Rönmark, Caroline Stridsman, Helena Backman, Anne Lindberg, Bo Lundbäck, Linnéa Hedman
ERJ Open Research 2020 6: 00620-2020; DOI: 10.1183/23120541.00620-2020
Linnéa Almqvist
1Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
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Eva Rönmark
1Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
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  • ORCID record for Eva Rönmark
Caroline Stridsman
2Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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Helena Backman
1Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
3Dept of Health Sciences, Luleå University of Technology, Luleå, Sweden
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Anne Lindberg
2Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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Bo Lundbäck
4Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenborg, Sweden
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Linnéa Hedman
1Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
3Dept of Health Sciences, Luleå University of Technology, Luleå, Sweden
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  • For correspondence: linnea.hedman@norrbotten.se
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  • FIGURE 1
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    FIGURE 1

    Flow chart of the study population.

  • FIGURE 2
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    FIGURE 2

    Remission and relapse of adult-onset asthma, from recruitment between 1995 and 1999 until follow-up between 2012 and 2014.

  • FIGURE 3
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    FIGURE 3

    Remission of adult-onset asthma at follow-up between 2012 and 2014 in relation to forced expiratory volume in 1 s (FEV1) % predicted and severe bronchial hyperreactivity (BHR; PC20 ≤1 mg·mL−1) at recruitment between 1995 and 1999. Logistic regression analyses, presented as unadjusted and adjusted for sex, age, family history of asthma, body mass index and smoking habits at recruitment. PC20: provocative concentration causing a 20% fall in FEV1.

Tables

  • Figures
  • TABLE 1

    Classification of asthma control according to Global Initiative for Asthma 2006

    ControlledPartly controlledUncontrolled
    (all of the below)(any of the below)(at least 3 of the below)
    During the last 4 weeks:
     Asthma symptoms during the dayTwice or less per weekThree times or more per weekThree times or more per week
     Limitation of daily activitiesNoYesYes
     Asthma symptoms during the nightNoYesYes
     Reliever medicationUsed twice or less per weekUsed three times or more per weekUsed three times or more per week
     Lung functionFEV1 >80% predictedFEV1 <80% predictedFEV1 <80% predicted
    During the last 12 months:
     Exacerbations#NoAt least oneAt least one

    #: any of the following events in the last 12 months due to asthma: oral corticosteroids and/or antibiotics, emergency healthcare visit with or without hospitalisation, or not being able to work or perform daily activities due to asthma during at least 2 days. FEV1: forced expiratory volume in 1 s. Reproduced from [29] with permission.

    • TABLE 2

      Basic and clinical characteristics at recruitment between 1995 and 1999, comparing subjects in remission and subjects with persistent asthma at follow-up

      AllPersistent asthmaRemissionp-value
      Subjects n20518223
      Female sex134 (65.4)121 (66.5)13 (56.5)0.344
      Age at asthma onset39.3±10.339.4±10.238.6±11.60.718
      BMI25.9±4.525.9±4.426.7±4.70.386
      Family history of asthma83 (40.5)77 (42.3)6 (26.1)0.135
      BMI classification
       Normal weight95 (46.3)85 (46.7)10 (43.5)
       Overweight79 (38.5)70 (38.5)9 (39.1)
       Obesity31 (15.1)27 (14.8)4 (17.4)0.717+
      Smoking habits
       Nonsmoker105 (51.2)95 (52.2)10 (43.5)
       Ex-smoker64 (31.2)57 (31.3)7 (30.4)
       Current smoker36 (17.6)30 (16.5)6 (26.1)0.276+
       Occupational exposure to gas, dust or fumes66 (33.3)61 (34.9)5 (21.7)0.210
      Educational level
       Primary school21 (10.5)20 (11.3)1 (4.3)
       High school92 (46.0)81 (45.8)11 (47.8)
       Higher education87 (43.5)76 (42.9)11 (47.8)0.417+
      Lung function
       FEV1 % predicted89.0±13.488.3±13.794.6±10.10.034
       FVC % predicted87.1±11.686.5±11.792.0±9.50.034
      Bronchial hyperreactivity PC20#
       PC20 ≤1 mg·mL−189 (48.1)83 (50.9)6 (27.3)0.037
       PC20 ≤2 mg·mL−1120 (64.9)109 (66.9)11 (50.0)0.120
      Atopic comorbidities
       Hay fever82 (40.0)73 (40.1)9 (39.1)0.928
       Eczema68 (33.2)62 (34.1)6 (26.1)0.444
       Nasal polyps21 (10.2)20 (11.0)1 (4.3)0.285
       Positive skin-prick test¶85 (42.1)75 (41.9)10 (43.5)0.885

      Data are presented as n (%) or mean±sd, unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; PC20: provocative concentration causing a 20% fall in FEV1. #: among the 185 participating in metacholine challenge test at recruitment; ¶: among the 202 participating in skin-prick test; +: analysis performed in a 3×2 table. Bold values indicate p<0.05.

      • TABLE 3

        Changes in BMI, weight and smoking habits from recruitment to follow-up, and lung function, blood neutrophils and eosinophils and allergic sensitisation at follow-up between 2012 and 2014, comparing subjects in remission and subjects with persistent asthma

        Persistent asthmaRemissionp-value
        Subjects n18223
        Changes in BMI and weight
         BMI change3.0±3.31.6±3.30.054
         % weight change10.3±0.14.9±0.10.059
         Weight loss23 (12.6)6 (26.1)
         Stable weight28 (15.4)5 (21.7)
         Weight gain131 (72.0)12 (52.2)0.118+
        Changes in smoking habits
         Nonsmoker to nonsmoker90 (49.5)10 (43.5)
         Ex-smoker to ex-smoker (mean 11.9 pack-years)57 (31.3)7 (30.4)
         Ex-smoker to smoker00
         Smoker to smoker (mean 21.1 pack-years)9 (4.9)4 (17.4)
         Smoker to ex-smoker (mean 8.7 pack-years)26 (14.3)2 (8.7)0.753§
         Pack-years at follow-up11.4 (11.7)17.7 (12.2)0.074
        Lung function at follow-up
         FEV1 pp89.0±14.096.7±11.80.014
         FVC pp94.6±14.2101.1±14.50.043
         FEV1 reversibility ≥12% and ≥200 mL12 (7.1)1 (4.5)0.547
        Blood neutrophils 109·L−1 at follow-up#
         ≥467 (39.4)8 (34.8)0.669
         ≥521 (12.4)3 (13.0)0.570
         ≥69 (5.3)2 (8.7)0.386
         mean±sd3.8±1.24.0±2.20.406
        Blood eosinophils 109·L−1 at follow-up#
         ≥0.280 (47.1)12 (52.2)0.645
         ≥0.339 (22.9)4 (17.4)0.383
         ≥0.423 (13.5)2 (8.7)0.399
         mean±sd0.2±0.20.2±0.10.547
        Allergic sensitisation at follow-up¶
         Specific IgE >0.35 IU·mL−150 (28.4)5 (21.7)0.501
         Sensitisation to any pollen37 (21.0)5 (21.7)0.937
         Sensitisation to any furry animal30 (17.0)4 (17.4)0.580

        Data are presented as n (%) or mean±sd, unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; Ig: immunoglobulin. #: among the 193 participating in blood sampling for cell count at follow-up; ¶: among the 199 participating in blood samples for IgE at follow-up; +: analysis performed in a 3×2 table; §: analysis performed in a 5×2 table. Bold values indicate p<0.05.

        • TABLE 4

          Characteristics of subjects with persistent asthma at follow-up, by asthma control classified according to Global Initiative for Asthma 2006 [29] criteria

          Controlled asthmaPartly controlled asthmaUncontrolled asthmap-value
          Subjects n1005824
          Female sex63 (63.0)40 (69.0)18 (75.0)0.476
          Age at follow-up53.7±9.755.7±10.456.3±10.10.327
          Age at asthma onset38.2±10.040.7±10.541.1±10.30.232
          BMI28.8±5.129.3±6.028.0±3.50.579
          BMI classification
           Normal weight19 (19.0)13 (22.4)7 (29.2)
           Overweight50 (50.0)19 (32.8)10 (41.7)
           Obesity31 (31.0)26 (44.8)7 (29.2)0.216+
          Smoking habits and occupational exposure
           Nonsmoker50 (50.0)28 (48.3)12 (50.0)
           Ex-smoker45 (45.0)27 (46.6)11 (45.8)
           Current smoker5 (5.0)3 (5.2)1 (4.2)0.999§
           Pack-years11.3±12.012.1±11.19.8±12.50.846
           Occupational exposure to gas, dust or fumes36 (37.1)14 (24.6)11 (52.4)0.057
          Lung function
           Pre-bronchodilator FEV1 pp91.9±11.485.0±15.486.6±17.60.008
           Pre-bronchodilator FVC pp97.4±12.691.1±15.191.7±16.10.015
           Pre-bronchodilator FEV1/FVC <0.7029 (29.9)22 (37.9)8 (33.3)0.588
           AfterFEV1/FVC <0.7013 (14.0)15 (26.8)4 (19.0)0.153
           FEV1 reversibility ≥12% and ≥200 mL5 (5.4)6 (10.7)1 (4.8)0.425
          Comorbidities
           Current allergic rhinitis37 (37.0)29 (50.0)10 (41.7)0.279
           Current eczema18 (18.0)11 (19.0)5 (20.8)0.948
           Reflux39 (39.0)25 (43.1)10 (41.7)0.875
           Nasal polyps8 (7.1)5 (8.6)00.350
          Blood neutrophils 109·L−1#
           ≥434 (37.4)18 (32.1)15 (65.2)0.020
           ≥510 (11.0)5 (8.9)6 (26.1)0.092
           ≥63 (3.3)3 (5.4)3 (13.0)0.176
            mean±sd3.7 (1.1)3.6 (1.2)4.4 (1.5)0.017
          Blood eosinophils 109·L−1#
           ≥ 0.240 (44.0)30 (53.6)10 (43.5)0.491
           ≥0.316 (17.6)17 (30.4)6 (26.1)0.187
           ≥0.48 (8.8)11 (19.6)4 (17.4)0.147
           mean±sd0.2 (0.1)0.2 (0.2)0.2 (0.2)0.146
          Allergic sensitisation¶
           Specific IgE >0.35 IU·mL−127 (27.8)18 (32.7)5 (20.8)0.550
           Sensitisation to any pollen19 (19.6)15 (27.3)3 (12.5)0.292
           Sensitisation to any furred animal17 (17.5)10 (18.2)3 (12.5)0.812

          Data are presented as n (%) or mean±sd, unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; Ig: immunoglobulin. #: among the 170 participating in blood sampling for cell count; ¶: among the 176 participating in blood sampling for IgE; +: analysis performed in a 3×3 table. Bold values indicate p<0.05.

          • TABLE 5

            Any respiratory symptoms and use of asthma medication classified according to asthma treatment among subjects with persistent asthma, by asthma control classified according to Global Initiative for Asthma 2006 criteria [29] at follow-up

            All#Controlled asthmaPartly controlled asthmaUncontrolled asthmap-value
            Subjects n1821005824
            Any respiratory symptoms at follow-up164 (90.1)88 (88.0)52 (89.7)24 (100.0)0.207
            Treatment at follow-up
             No treatment36 (19.8)28 (28.0)8 (13.8)0 (0)
             SABA or LABA without ICS24 (13.2)16 (16.0)7 (12.1)1 (4.2)
             ICS with SABA or LABA periodically28 (15.4)17 (17.0)9 (15.5)2 (8.3)
             Low-dose ICS without LABA most days per week20 (11.0)9 (9.0)9 (15.5)2 (8.3)
             Low-dose ICS and LABA most days per week17 (9.3)7 (7.0)5 (8.6)5 (20.8)
             Medium/high-dose ICS and LABA most days per week57 (31.3)23 (23.0)20 (34.5)14 (58.3)0.004

            Data are presented as n (%), unless otherwise stated. SABA: short-acting β2 agonist; LABA: long-acting β2 agonist; ICS: inhaled corticosteroid. #: n=182. Bold values indicate p<0.05.

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            Remission of adult-onset asthma is rare: a 15-year follow-up study
            Linnéa Almqvist, Eva Rönmark, Caroline Stridsman, Helena Backman, Anne Lindberg, Bo Lundbäck, Linnéa Hedman
            ERJ Open Research Oct 2020, 6 (4) 00620-2020; DOI: 10.1183/23120541.00620-2020

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            Remission of adult-onset asthma is rare: a 15-year follow-up study
            Linnéa Almqvist, Eva Rönmark, Caroline Stridsman, Helena Backman, Anne Lindberg, Bo Lundbäck, Linnéa Hedman
            ERJ Open Research Oct 2020, 6 (4) 00620-2020; DOI: 10.1183/23120541.00620-2020
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