Novel insights on trajectories of asthma over time, extrapulmonary comorbidities

In a new study, distinct longitudinal trajectories of asthma and allergies from childhood to middle age were associated with different profiles of extrapulmonary comorbidities and risk for COPD.

Researchers performed a prospective cohort study to assess longitudinal trajectories of asthma and allergic diseases from childhood to middle age and evaluate the associations with lung function and profiles of extrapulmonary comorbidities. The researchers analyzed data on asthma and related allergic conditions from 3,609 participants of the Tasmanian Longitudinal Health Study. The researchers identified longitudinal trajectories of asthma and allergic diseases from age 7 to 53 years and profiles of self-reported extrapulmonary conditions recorded at 53 years.

The researchers identified five distinct longitudinal trajectories of asthma and allergic diseases: minimal and least asthma and allergies (49%), late-onset hay fever without asthma (29.5%), late-onset asthma and allergies (8.8%), early-onset remitted asthma and allergies (6.5%) and early-onset persistent asthma and allergies (6.2%).

Additionally, four profiles of extrapulmonary comorbidities were identified: minimal or least disease (61.1%), dominant mental health disorders (23.9%), dominant cardiovascular diseases or risks (11.7%) and multiple disorders (3.2%).

Results showed that the multiple disorders profile was predominantly associated with the late-onset asthma and allergies trajectory (RR = 3.3; 95% CI, 9-5.9). Other asthma and allergy trajectories were associated with only the dominant mental health disorders profile.

COPD was strongly associated with the early-onset persistent asthma and allergies trajectory (OR = 5.3; 95% CI, 3.2-8.6) and late-onset asthma and allergies trajectory (OR = 3.8; 95% CI, 2.4-6.1), according to the results.

“These findings can help refine a personalized approach in clinical guidelines related to treatable traits of asthma, in which profiles of comorbidity become a new target,” Dinh S. Bui, PhD, PhD candidate at the Allergy and Lung Health Unit in the Centre for Epidemiology and Biostatistics at Melbourne School of Population and Global Health, Australia, and colleagues wrote in The Lancet Respiratory Medicine. “The findings also suggest potential high-risk groups that should be targeted for intense monitoring to reduce the burden of both lung function deficits and extrapulmonary comorbidities among people with asthma. Finally, our findings propose new inflammatory paradigms responsible for asthma and multimorbidities.”