TY - JOUR T1 - Incidence and predictors of asthma exacerbations in middle-aged and older adults: the Rotterdam Study JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00126-2021 SP - 00126-2021 AU - Emmely W. de Roos AU - Lies Lahousse AU - Katia M.C. Verhamme AU - Gert-Jan Braunstahl AU - Johannes J.C.C.M. in ‘t Veen AU - Bruno H. Stricker AU - Guy G.O. Brusselle Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/04/15/23120541.00126-2021.abstract N2 - Aim To investigate occurrence and determinants of asthma exacerbations in an ageing general population.Methods Subjects aged 45 years or above with physician-diagnosed asthma in the Rotterdam Study, a population-based prospective cohort from January 1991 to May 2018 were assessed for asthma exacerbations. Exacerbations were defined as acute episodes of worsening asthma treated with oral corticosteroids. Cox proportional hazards analysis was used to investigate risk factors for a future exacerbation.Results Out of 763 participants with asthma (mean age 61.3 years, 69.2% female), 427 (56.0%) experienced at least one exacerbation, in a mean follow-up time of 13.9 years. The mean annual exacerbation rate was 0.22. Most exacerbations occurred during winter months. Risk factors for exacerbations were a history of previous exacerbations (Hazard Ratio (HR) 4.25; CI 3.07–5.90, p<0.001)), respiratory complaints (HR 2.18; 1.48–3.21, p<0.001), airflow obstruction (HR 1.52; 1.07–2.15, p=0.019), obesity (HR 1.38; 1.01–1.87, p=0.040) and depressive symptoms (HR 1.55; 1.05–2.29, p=0.027). Compared to those not using respiratory medication, we observed higher HRs for those on short-acting beta2-agonists (SABA, i.e. rescue medication) only (HR 3.08, 95% CI 1.61–5.90, p=0.001) than those on controller medication (HR 2.50, 95% CI 1.59–3.92, p<0.001).Conclusion Many older adults with asthma suffer from at least one severe exacerbation. Previous exacerbations, use of SABA without concomitant controller medication, respiratory complaints, obesity, airway obstruction and depression are independent risk factors for exacerbations.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. de Roos has nothing to disclose.Conflict of interest: Dr. Lahousse has nothing to disclose.Conflict of interest: Dr. Verhamme reports and KV works for a research group who received/receives unconditional research grants from Yamanouchi, Pfizer-Boehringer Ingelheim, Novartis, GSK, Chiesi, Amgen.Conflict of interest: Dr. Braunstahl reports grants from GSK, personal fees from Novartis, grants from AstraZeneca, grants from Chiesi, grants and personal fees from ALK Abello, grants from Teva, personal fees from Sanofi, outside the submitted work.Conflict of interest: J.J.C.C.M. in 't Veen reports faculty grants from Teva, Chiesi, Boehringer Ingelheim and AstraZeneca, and speaker bureau and advisory board fees from Sanofi, outside the submitted work.Conflict of interest: Dr. Stricker has nothing to disclose.Conflict of interest: G.G.O. Brusselle reports advisory board fees from Amgen, Boehringer Ingelheim, Novartis, Sanofi and Teva, and advisory board and lecture fees from AstraZeneca, Chiesi and GlaxoSmithKline, outside the submitted work. ER -