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J Allergy Clin Immunol Pract. 2018 Mar - Apr;6(2):545-554.e4. doi: 10.1016/j.jaip.2017.05.032. Epub 2017 Aug 31.

Baseline Features of the Severe Asthma Research Program (SARP III) Cohort: Differences with Age.

Author information

1
University of Virginia School of Medicine, Charlottesville, Va. Electronic address: wgt2p@virginia.edu.
2
Pennsylvania State University School of Medicine, Hershey, Pa.
3
University of California, San Francisco School of Medicine, San Francisco, Calif.
4
University of Pittsburgh School of Medicine, Pittsburgh, Pa.
5
Emory University School of Medicine, Atlanta, Ga.
6
Wake Forest University School of Medicine, Winston-Salem, NC.
7
Washington University School of Medicine, St. Louis, Mo.
8
University of Wisconsin School of Medicine, Madison, Wis.
9
Case Western Reserve University School of Medicine, Cleveland, Ohio.
10
Cleveland Clinic School of Medicine, Cleveland, Ohio.
11
University of Virginia School of Medicine, Charlottesville, Va.
12
Virginia Commonwealth University School of Medicine, Richmond, Va.
13
Harvard University School of Medicine, Boston, Mass.

Abstract

BACKGROUND:

The effect of age on asthma severity is poorly understood.

OBJECTIVES:

The objective of this study was to compare the baseline features of severe and nonsevere asthma in the Severe Asthma Research Program (SARP) III cohort, and examine in cross section the effects of age on those features.

METHODS:

SARP III is a National Institutes of Health/National Heart Lung Blood Institute multisite 3-year cohort study conducted to investigate mechanisms of severe asthma. The sample included 188 children (111 severe, 77 nonsevere) and 526 adults (313 severe, 213 nonsevere) characterized for demographic features, symptoms, health care utilization, lung function, and inflammatory markers compared by age and severity.

RESULTS:

Compared with children with nonsevere asthma, children with severe asthma had more symptoms and more historical exacerbations, but no difference in body weight, post-bronchodilator lung function, or inflammatory markers. After childhood, and increasing with age, the cohort had a higher proportion of women, less allergen sensitization, and overall fewer blood eosinophils. Enrollment of participants with severe asthma was highest in middle-aged adults, who were older, more obese, with greater airflow limitation and higher blood eosinophils, but less allergen sensitization than adults with nonsevere asthma.

CONCLUSIONS:

The phenotypic features of asthma differ by severity and with advancing age. With advancing age, patients with severe asthma are more obese, have greater airflow limitation, less allergen sensitization, and variable type 2 inflammation. Novel mechanisms besides type 2 inflammatory pathways may inform the severe asthma phenotype with advancing age.

KEYWORDS:

Asthma phenotypes; Severe asthma

PMID:
28866107
PMCID:
PMC5832534
[Available on 2019-03-01]
DOI:
10.1016/j.jaip.2017.05.032
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