Risks for asthma increase with atopic dermatitis
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Key takeaways:
- Children with atopic dermatitis had about twice the risk for developing asthma than children without AD.
- Adults with AD had a 38% greater risk for developing asthma than adults without AD.
Patients with atopic dermatitis experienced greater risks for asthma, asthma exacerbations and hospitalizations than those without AD, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
These risks increased with the severity of the AD, Joy Wan, MD, MSCE, assistant professor of dermatology, department of dermatology, Johns Hopkins University School of Medicine, and colleagues wrote.
The researchers examined records of both children and adults in The Health Improvement Network, which comprises more than 600 general practices in the United Kingdom, from 1994 to 2015.
Results among children
These records included 409,431 children with AD, including 93.2% whose disease was classified as mild (median age, 4 years), 5.5% with moderate AD (median age, 9 years) and 1.3% with severe AD (median age, 5 years), as well as 1,809,029 children who did not have AD (median age, 4 years).
Also, there were 169,679 children with asthma who did not have AD, or 9.4% of the total cohort of children without AD, and 57,098 children with asthma who did have AD, or 13.9% of the total cohort of children with AD.
Overall, the researchers said that children with AD had greater rates of asthma, asthma exacerbations and asthma hospitalizations than children who did not have it and that these rates increased with the severity of the AD.
Children with AD had approximately twice the risk for new-onset asthma than those who did not have AD (HR = 1.96; 95% CI, 1.93-1.98). Specific hazard ratios for developing asthma included 1.82 (95% CI, 1.8-1.85) for mild AD, 3.24 (95% CI, 3.13-3.35) for moderate AD and 3.7 (95% CI, 3.5-3.92) for severe AD.
Among all children with asthma, those who also had AD had 63% greater risk for asthma exacerbation than those who did not have AD (HR = 1.63; 95% CI, 1.59-1.68). Hazard ratios for exacerbations included 2.33 (95% CI, 2.21-2.47) for children with moderate AD and 2.69 (95% CI, 2.45-2.95) for children with severe AD.
Similarly, children with AD and asthma were 64% more likely to be hospitalized for asthma than children who only had asthma, with risks increasing to 163% higher for children with moderate AD and 195% higher for children with severe AD. Children with AD had 3,862 excess exacerbations and 1,381 excess hospitalizations as well.
Results among adults
The study also examined records from 625,083 adults with AD (median age range among severity groups, 45-50 years), including 65.7% classified as mild, 31.4% with moderate AD and 2.9% severe, and 2,678,888 adults who did not have AD (median age, 47 years).
The adults with asthma included 346,024 who did not have AD, representing 12.9% of the total cohort of adults who did not have AD, and 127,459 who did have AD, representing 20.4% of the total cohort of adults who did have AD.
Like the pediatric population, adults with AD had greater incidence rates of asthma, asthma exacerbations and asthma hospitalizations than those who did not have AD, and these rates increased with greater AD severity as well.
Adults with AD had 38% greater risk for incident asthma than adults who did not have AD (HR = 1.38; 95% CI, 1.36-1.4). Specific risks for asthma included 27% with mild AD, 52% with moderate AD and 58% with severe AD.
Adults with asthma and AD had 21% greater risk for exacerbations than adults who only had asthma. Hazard ratios for exacerbation included 1.13 (95% CI, 1.1-1.17) for mild AD, 1.3 (95% CI, 1.26-1.34) for moderate AD and 1.37 (95% CI, 1.27-1.48) for severe AD. Adults with AD also had 1,843 excess exacerbations and 891 excess hospitalizations.
Conclusions, next steps
Based on these findings, the researchers concluded that patients with AD had significantly greater risks for incident asthma in addition to exacerbations and hospitalizations related to asthma than those patients who did not have asthma.
Also, these risks increased with the severity of AD. They were more pronounced among children compared with adults as well, which the researchers suggested may indicate that the atopic march may be less common among older patients with AD.
The researchers called for additional studies to explore the relationships between different AD and asthma endotypes and how they may vary by age.
Perspective
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Overall, the results of this study are very helpful to provide more insight into the link between AD and asthma. As we have now entered an era with different targeted and broad treatments for these conditions, both of which are rising in prevalence, and with additional new treatments on the horizon, better understanding of the interplay between AD and asthma may help to improve treatment approaches for both. Next steps for research might include additional work to understand how different therapeutic interventions for AD may impact outcomes in asthma and vice versa.
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