Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study

Esmé J. Baan; Emmely W. de Roos; Marjolein Engelkes; Maria de Ridder; Lars Pedersen; Klara Berencsi; Dani Prieto-Alhambra; Francesco Lapi; Melissa K. Van Dyke; Peter Rijnbeek; Guy G. Brusselle; Katia M.C. Verhamme

doi:10.1016/j.jaip.2022.03.019

Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study

Esmé J. Baan, Emmely W. de Roos, Marjolein Engelkes, Maria de Ridder, Lars Pedersen, Klara Berencsi, Dani Prieto-Alhambra, Francesco Lapi, Melissa K. Van Dyke, Peter Rijnbeek, Guy G. Brusselle, Katia M.C. Verhamme^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood. Objective: To investigate differences in patients’ characteristics by age at asthma onset. Methods: From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18–40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (OR_adj) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model. Results: In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (OR_adj 1.4; 95% CI 1.1–1.8) and lower risks for atopic disorders (OR_adj 0.8; 95% CI 0.7–0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (OR_adj 1.8; 95% CI 1.2–2.6), overweight/obesity (OR_adj 1.3; 95% CI 1.2–1.4), gastroesophageal reflux disease (OR_adj 1.4; 95% CI 1.2–1.7), and diabetes (OR_adj 2.3; 95% CI 1.8–2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (OR_adj 2.8; 95% CI 1.7–4.5). Conclusions: This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.

Original language	English
Pages (from-to)	1825-1834.e8
Journal	Journal of Allergy and Clinical Immunology: In Practice
Volume	10
Issue number	7
Early online date	7 Apr 2022
DOIs	https://doi.org/10.1016/j.jaip.2022.03.019
Publication status	Published - 1 Jul 2022

Bibliographical note

Funding Information:
This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest.

Funding Information:
Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier , outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi , GSK , and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca , Boehringer-Ingelheim, Chiesi , GlaxoSmithKline , Novartis , Sanofi , and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer / Boehringer Ingelheim , Novartis , Chiesi , Amgen , and UCB . The rest of the authors declare that they have no relevant conflicts of interest.

Funding Information:
This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).

Publisher Copyright:
© 2022 The Authors

Funding Information:
This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest.

Funding Information:
This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).

Publisher Copyright:
© 2022 The Authors

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10.1016/j.jaip.2022.03.019

Characterization of Asthma by Age of Onset A Multi-Database Cohort StudyFinal published version, 1.77 MBLicence: CC BY

http://www.jaci-inpractice.org/article/S2213219822003300/pdfLicence: CC BY

Cite this

Baan, E. J., de Roos, E. W., Engelkes, M., de Ridder, M., Pedersen, L., Berencsi, K., Prieto-Alhambra, D., Lapi, F., Van Dyke, M. K., Rijnbeek, P., Brusselle, G. G., & Verhamme, K. M. C. (2022). Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study. Journal of Allergy and Clinical Immunology: In Practice, 10(7), 1825-1834.e8. https://doi.org/10.1016/j.jaip.2022.03.019

@article{3f106c8533e34d2eac79ff87167a545a,

title = "Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study",

abstract = "Background: Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood. Objective: To investigate differences in patients{\textquoteright} characteristics by age at asthma onset. Methods: From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18–40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (ORadj) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model. Results: In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (ORadj 1.4; 95% CI 1.1–1.8) and lower risks for atopic disorders (ORadj 0.8; 95% CI 0.7–0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (ORadj 1.8; 95% CI 1.2–2.6), overweight/obesity (ORadj 1.3; 95% CI 1.2–1.4), gastroesophageal reflux disease (ORadj 1.4; 95% CI 1.2–1.7), and diabetes (ORadj 2.3; 95% CI 1.8–2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (ORadj 2.8; 95% CI 1.7–4.5). Conclusions: This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.",

author = "Baan, {Esm{\'e} J.} and {de Roos}, {Emmely W.} and Marjolein Engelkes and {de Ridder}, Maria and Lars Pedersen and Klara Berencsi and Dani Prieto-Alhambra and Francesco Lapi and {Van Dyke}, {Melissa K.} and Peter Rijnbeek and Brusselle, {Guy G.} and Verhamme, {Katia M.C.}",

note = "Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier , outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi , GSK , and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca , Boehringer-Ingelheim, Chiesi , GlaxoSmithKline , Novartis , Sanofi , and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer / Boehringer Ingelheim , Novartis , Chiesi , Amgen , and UCB . The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284). Publisher Copyright: {\textcopyright} 2022 The Authors Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284). Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jul,

day = "1",

doi = "10.1016/j.jaip.2022.03.019",

language = "English",

volume = "10",

pages = "1825--1834.e8",

journal = "Journal of Allergy and Clinical Immunology: In Practice",

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publisher = "American Academy of Allergy, Asthma and Immunology",

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Baan, EJ, de Roos, EW, Engelkes, M, de Ridder, M, Pedersen, L, Berencsi, K, Prieto-Alhambra, D, Lapi, F, Van Dyke, MK, Rijnbeek, P , Brusselle, GG & Verhamme, KMC 2022, 'Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study', Journal of Allergy and Clinical Immunology: In Practice, vol. 10, no. 7, pp. 1825-1834.e8. https://doi.org/10.1016/j.jaip.2022.03.019

TY - JOUR

T1 - Characterization of Asthma by Age of Onset

T2 - A Multi-Database Cohort Study

AU - Baan, Esmé J.

AU - de Roos, Emmely W.

AU - Engelkes, Marjolein

AU - de Ridder, Maria

AU - Pedersen, Lars

AU - Berencsi, Klara

AU - Prieto-Alhambra, Dani

AU - Lapi, Francesco

AU - Van Dyke, Melissa K.

AU - Rijnbeek, Peter

AU - Brusselle, Guy G.

AU - Verhamme, Katia M.C.

N1 - Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier , outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi , GSK , and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca , Boehringer-Ingelheim, Chiesi , GlaxoSmithKline , Novartis , Sanofi , and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer / Boehringer Ingelheim , Novartis , Chiesi , Amgen , and UCB . The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284). Publisher Copyright: © 2022 The Authors Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284).Conflicts of interest: M. Engelkes reports grants from GSK during the conduct of the study. M. de Ridder reports grants from GSK during the conduct of the study. D. Prieto-Alhambra reports grants and other from AMGEN; grants, nonfinancial support, and other from UCB Biopharma; grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums; and Synapse Management Partners have supported training programs organized by D. Prieto-Alhambra's department and open for external participants. F. Lapi reports grants from Chiesi, GSK, and Novartis during the conduct of the study. M. K. Van Dyke is a GSK employee and shareholder. P. Rijnbeek receives an unconditional grant from Janssen Research & Development and funding through the Innovative Medicines Initiative. G. G. Brusselle has received fees for advisory boards or lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. K. M. C. Verhamme works for a research group that, in the past, received unconditional research grants from Yamanouchi, Pfizer/Boehringer Ingelheim, Novartis, Chiesi, Amgen, and UCB. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This project was supported by an unconditional research grant by GlaxoSmithKline (GSK) (PRJ2284). Publisher Copyright: © 2022 The Authors

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood. Objective: To investigate differences in patients’ characteristics by age at asthma onset. Methods: From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18–40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (ORadj) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model. Results: In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (ORadj 1.4; 95% CI 1.1–1.8) and lower risks for atopic disorders (ORadj 0.8; 95% CI 0.7–0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (ORadj 1.8; 95% CI 1.2–2.6), overweight/obesity (ORadj 1.3; 95% CI 1.2–1.4), gastroesophageal reflux disease (ORadj 1.4; 95% CI 1.2–1.7), and diabetes (ORadj 2.3; 95% CI 1.8–2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (ORadj 2.8; 95% CI 1.7–4.5). Conclusions: This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.

AB - Background: Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood. Objective: To investigate differences in patients’ characteristics by age at asthma onset. Methods: From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18–40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (ORadj) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model. Results: In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (ORadj 1.4; 95% CI 1.1–1.8) and lower risks for atopic disorders (ORadj 0.8; 95% CI 0.7–0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (ORadj 1.8; 95% CI 1.2–2.6), overweight/obesity (ORadj 1.3; 95% CI 1.2–1.4), gastroesophageal reflux disease (ORadj 1.4; 95% CI 1.2–1.7), and diabetes (ORadj 2.3; 95% CI 1.8–2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (ORadj 2.8; 95% CI 1.7–4.5). Conclusions: This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.

UR - http://www.scopus.com/inward/record.url?scp=85130389741&partnerID=8YFLogxK

U2 - 10.1016/j.jaip.2022.03.019

DO - 10.1016/j.jaip.2022.03.019

M3 - Article

C2 - 35398554

AN - SCOPUS:85130389741

SN - 2213-2198

VL - 10

SP - 1825-1834.e8

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

IS - 7

ER -

Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study

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