TY - JOUR

T1 - Severe asthma trajectories in adults

T2 - findings from the NORDSTAR cohort

AU - von Bülow, Anna

AU - Hansen, Susanne

AU - Sandin, Patrik

AU - Ernstsson, Olivia

AU - Janson, Christer

AU - Lehtimäki, Lauri

AU - Kankaanranta, Hannu

AU - Ulrik, Charlotte

AU - Aarli, Bernt Bøgvald

AU - Geale, Kirk

AU - Tang, Sheila Tuyet

AU - Wolf, Maija

AU - Backer, Vibeke

AU - Hilberg, Ole

AU - Altraja, Alan

AU - Backman, Helena

AU - Lúdvíksdóttir, Dóra

AU - Björnsdóttir, Unnur Steina

AU - Kauppi, Paula

AU - Sandström, Thomas

AU - Sverrild, Asger

AU - Yasinska, Valentyna

AU - Kilpeläinen, Maritta

AU - Dahlén, Barbro

AU - Viinanen, Arja

AU - Bjermer, Leif

AU - Bossios, Apostolos

AU - Porsbjerg, Celeste

N1 - Funding Information: Support statement: This study is presented on behalf of the NORDSTAR study group. NORDSTAR is a pan-Nordic multiparty research collaboration platform governed by the Nordic Severe Asthma Network (NSAN). Data management and analyses are conducted by Quantify Research (Stockholm, Sweden). NORDSTAR is financially supported by Novartis and Sanofi and Regeneron Pharmaceuticals. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: Copyright ©The authors 2023.

PY - 2023

Y1 - 2023

N2 - Background There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with severe asthma. Methods We conducted an observational study based on Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified adult patients with severe asthma in 2018 according to the European Respiratory Society/American Thoracic Society definition and used latent class analysis to identify trajectories of asthma severity over a 10-year retrospective period from 2018. Results Among 169 128 asthma patients, we identified 4543 severe asthma patients. We identified four trajectories of severe asthma that were labelled as: trajectory 1 “consistently severe asthma” (n=389 (8.6%)), trajectory 2 “gradual onset severe asthma” (n=942 (20.7%)), trajectory 3 “intermittent severe asthma” (n=1685 (37.1%)) and trajectory 4 “sudden onset severe asthma” (n=1527 (33.6%)). “Consistently severe asthma” had a higher daily inhaled corticosteroid dose and more prevalent osteoporosis compared with the other trajectories. Patients with “gradual onset severe asthma” and “sudden onset severe asthma” developed type 2-related comorbidities concomitantly with development of severe asthma. In the latter group, this primarily occurred within 1–3 years preceding onset of severe asthma. Conclusions Four distinct trajectories of severe asthma were identified illustrating different patterns of progression of asthma severity. This may eventually enable the development of better preventive management strategies in severe asthma.

AB - Background There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with severe asthma. Methods We conducted an observational study based on Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified adult patients with severe asthma in 2018 according to the European Respiratory Society/American Thoracic Society definition and used latent class analysis to identify trajectories of asthma severity over a 10-year retrospective period from 2018. Results Among 169 128 asthma patients, we identified 4543 severe asthma patients. We identified four trajectories of severe asthma that were labelled as: trajectory 1 “consistently severe asthma” (n=389 (8.6%)), trajectory 2 “gradual onset severe asthma” (n=942 (20.7%)), trajectory 3 “intermittent severe asthma” (n=1685 (37.1%)) and trajectory 4 “sudden onset severe asthma” (n=1527 (33.6%)). “Consistently severe asthma” had a higher daily inhaled corticosteroid dose and more prevalent osteoporosis compared with the other trajectories. Patients with “gradual onset severe asthma” and “sudden onset severe asthma” developed type 2-related comorbidities concomitantly with development of severe asthma. In the latter group, this primarily occurred within 1–3 years preceding onset of severe asthma. Conclusions Four distinct trajectories of severe asthma were identified illustrating different patterns of progression of asthma severity. This may eventually enable the development of better preventive management strategies in severe asthma.

U2 - 10.1183/13993003.02474-2022

DO - 10.1183/13993003.02474-2022

M3 - Journal article

C2 - 37620041

AN - SCOPUS:85170581634

VL - 62

JO - The European respiratory journal

JF - The European respiratory journal

SN - 0903-1936

IS - 3

M1 - 2202474

ER -