Female patients and those under age 50 have a greater risk of severe asthma exacerbations and a lower health-related quality of life, despite having better lung function compared with male and older patients.
Female patients and adult patients younger than 50 had a greater risk of poor outcomes related to severe asthma, indicating that sex and age likely influence clinical characteristics and disease severity, according to a recent study.
The results were presented in a poster at the recent American Academy of Allergy, Asthma & Immunology 2021 Annual Meeting. The investigators suggested these patients could see benefits from increased disease awareness and more monitoring and intervention from health care professionals.
Severe asthma is estimated to affect between 5% and 10% of patients with asthma, who often require subspecialist care. Severe asthma is characterized by frequent exacerbations, poor control of symptoms, and high utilization of health care resources.
Researchers used data from the CHRONICLE trial, an ongoing observational study evaluating patients living in the United States who are aged 18 or older and have a diagnosis for severe asthma. Eligible patients are receiving biologic treatment, or systemic corticosteroids or other systemic immunosuppressants for half or more of the 12 months prior to enrollment, or have persistently uncontrolled asthma while receiving high-dosage inhaled corticosteroids and other controllers.
The current study included 1884 patients enrolled from February 2018 through February 2020. Pulmonary function tests were conducted at enrollment. Data on asthma exacerbations, emergency department visits, and hospitalizations were collected 12 months prior to enrollment and were updated every 6 months. Each patient was asked to complete the St. George’s Respiratory Questionnaire (SGRQ) to assess their health-related quality of life (HRQoL).
Among all patients, 69% were female, the mean age at enrollment was 54 years, and 56% experienced at least 1 exacerbation in the year before study enrollment. Daytime symptoms occurring more than 2 times per week were reported by 54% of patients and nighttime awakening and symptoms were reported by 39% of patients.
Female patients and those under age 50 were more likely to have an exacerbation during the 12 months prior to enrollment and worse HRQoL as assessed by the SGRQ scores, which range from 1 to 100, with higher scores indicating worse HRQoL.
On average, female patients had a higher body mass index and were more likely to have comorbid depression, anxiety, and thyroid disease. Female patients were also more frequently treated by a pulmonologist compared with their male counterparts.
Patients under age 50 had a higher prevalence of allergic rhinitis and nasal polyps compared with older patients, who were more likely to be former smokers, have chronic obstructive pulmonary disease, have hypertension, and have hypercholesterolemia.
Despite having higher annualized rates of exacerbations, patients who were female and under age 50 years old had better lung function compared with male and older patients.
The investigators suggested the greater disease burden among younger individuals may be associated with the greater incidence of nasal polyps and allergic comorbidities, leading to a potentially higher prevalence of eosinophilic and allergic disease compared with older patients.
“A better understanding of the effects of sex and age among adult patients with subspecialist-treated SA may help providers determine which patients need more intensive treatment and monitoring,” noted the investigators.
Lugogo N, Judson E, Haight E, et al. Effects of sex and age on characteristics of United States patients with severe asthma. Presented at the American Academy of Allergy, Asthma & Immunology 2021 Annual Meeting, February 26-March 1, 2021; Poster 147.