Abstract
Background: Phenotypic differences between early-onset (EODA) and adult-onset (AODA) difficult asthma in adulthood are not well described.
Aim: To characterise EODA and AODA in difficult asthma.
Methods: The Wessex AsThma CoHort of difficult asthma (WATCH) is a longitudinal study at University Hospital Southampton (UHS) UK set up in 2015. To date, 380 patients are enrolled from the UHS tertiary difficult asthma clinic. Clinical features of EODA (age ≤18 yrs) and AODA (age >18 yrs) are presented here.
Results: Of 368 patients with available data, 51.6% had EODA and 48.4% AODA (median age of onset 4.0 yrs v 40.5 yrs respectively (p<0.001)). AODA was more prevalent in males (58.9% v 42.7% p=0.003). Spirometry, FeNO and blood eosinophil count did not differ for EODA and AODA.
EODA had a greater proportion with eczema ever (30.6% v 10.3% p<0.001) and positive skin testing (78.8% v 56.1% p<0.001), alongside higher total IgE levels (IU/mL) (386.7 v 222.1 p=0.041) and omalizumab use (23.2% v 13.6% p=0.018).
Functional comorbidities were more prevalent in EODA; dysfunctional breathing (61.9% v 45.9% p=0.003), depression (42.9% v 32.1% p=0.045) and anxiety (40.0% v 24.4% p=0.003). Rhinitis, GORD and obesity did not differ, but COPD (14.3% v 3.7% p<0.001) and bronchiectasis (18.9% v 11.3% p=0.044) were higher in AODA. AODA had higher prevalence of smoking (55.4% v 41.1% p=0.006).
EODA had more ICU admissions in the past year (33.0% v 21.1% p=0.011) and intubation ever for asthma (17.1% v 9.7% p=0.040).
Conclusion: EODA is commoner in females and associated with more atopy, functional comorbidity, biologic therapy and healthcare need. AODA is commoner in males associated with smoking and comorbid lung disease.
Footnotes
Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, PA1086.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2018