Asthma and Allergies Trajectories Could Be Linked to Extrapulmonary Comorbidity Risk

Shyamali C. Dharmage, PhD

The trajectory of a patient’s asthma and allergies from childhood through adulthood may have an impact on the degree of a patient’s risk of extrapulmonary comorbidities and chronic obstructive pulmonary disorder (COPD), according to a new study.

As many as 1 in 13 people in the US have asthma, although in many cases children who are diagnosed with asthma have fewer or no symptoms of the disease as they progress into adulthood. In other cases, symptoms don’t come until later in life, and can persist throughout life.

Corresponding author Shyamali C. Dharmage, PhD, of the University of Melbourne, and colleagues noted that there is some evidence that longitudinal trajectories of asthma and allergies may be linked with different risk levels for COPD and other lung disorders. However, they said associations between asthma and allergy trajectory and extrapulmonary comorbidities have not been studied thoroughly.

In hopes of changing that, Dharmage and colleagues constructed a prospective cohort study using the Tasmanian Longitudinal Health Study to identify patients between the ages of 7-53 who had asthma and allergic conditions such as eczema, hay fever, and food allergies.

Invitations were issued to all surviving individuals in the database. Using latent class analysis, each individual in the study was categorized based on longitudinal trajectories of asthma and allergic conditions from childhood through most recent follow-up (the average age was 53 years). Profiles of patients were then built based on self-reported extra pulmonary conditions at 53 years. The authors then used regression modeling to investigate associations between those trajectories and comorbidities.

Of the 6128 patients invited to participate in the study, 3609 enrolled. Those patients were split into five asthma and allergy trajectories: about half (49.0%) were listed as minimal late-onset asthma and allergies; 29.5% were categorized as late-onset hay fever without asthma; 6.5% had early-onset remitted asthma and allergies; 8.8% were categorized as late-onset asthma and allergies; and the remaining 6.2% were found to have early-onset persistent asthma and allergies.

Those same patients were then put into 4 extrapulmonary morbidity profiles: 61.1% were characterized as having minimal or least disease; 23.9% had dominant mental health disorders; 11.7% had dominant cardiovascular diseases or risk for diseases; and 3.2% were listed as having “multiple disorders.”

The most distinct link was between the late-onset asthma and allergies trajectory and the multiple disorders profile (risk ratio [RR], 3.3) The other 4 trajectories were only associated with the dominant mental health disorders profiled.

Those in the early-onset persistent asthma and allergies trajectory had the highest risk of spirometrically defined and clinical COPD (odds ratio [OR], 5.3) followed by the late-onset asthma and allergies trajectory (OR, 3.8).

In short, Dharmage and colleagues said, their study supports the idea that the trajectory of a patient’s asthma and allergies can in fact help characterize their risk of other comorbidities and COPD. They said physicians should use these findings to guide monitoring and treatment decisions.

“These findings can inform a personalized approach in clinical guidelines and management focusing on treatable traits,” they said. “Comorbidity profiles are a new target for early identification and intervention.”

The study, “Trajectories of asthma and allergies from 7 years to 53 years and associations with lung function and extrapulmonary comorbidity profiles: a prospective cohort study,” was published online in The Lancet Respiratory Medicine.