Asthma Exacerbations Associated With Poor Lung Function

Early interventions might preserve lung function, particularly in younger patients with frequent asthma exacerbations, say authors.

Asthma exacerbations can wreak havoc in patients’ lives. Difficulty breathing can result in frequent trips to the emergency room visits, absences from work and a host of other problems. Asthma exacerbations are also associated with healthcare costs, burdening patients — and society overall — staggeringly high medical bills.

Exacerbations are believed to be a significant but potentially modifiable cause of declining lung function in some people.Loss of lung function over time is associated with comorbidities, including chronic shortness of breath and premature death.

In a study published in BMJ Thorax in August 2022, researchers investigated whether asthma exacerbations are associated with age-specific decline in lung function over time. Using data from the U.K. Optimum Patient Care Research Database (OPCRD), the researchers conducted an observational cohort study of 109,182 patients with active asthma ages 5 to 50 years. The primary outcome was peak expiratory flow rate (PEF) measured in liters per minute (L/min) and an analysis of the correlation between PEF and forced expiratory flow in 1 second (FEV1).

The investigators found that, compared with patients who had no exacerbations, those with exacerbations lost an estimated additional -1.34 L/min PEF per year with each episode. Young adults aged 18 to 24 years with asthma exacerbation rates of 2 or more per year lost an additional -5.95 L/min versus those who did not experience exacerbations. The results were similar with an FEV1 analysis. Increasing age was associated with increasingly smaller differences between the groups, and the correlation was stronger in patients ages 18 to 39 years.

The authors concluded that more frequent asthma exacerbations are associated with faster lung function deterioration. They suggest that early interventions might preserve lung function, particularly in younger patients with frequent asthma exacerbations. They wrote, “This finding underlines the need for a review of the management of patients at risk of accelerated decline before reaching 40 years of age.”