Clinical characteristics of patients with obesity associated with bronchial asthma, depending on the age of onset

Abstract

Introduction. Previous studies have identified two primary phenotypes of bronchial asthma (BA) associated with obesity: early atopic and late without atopy. These phenotypes differ in age of onset, pathogenic mechanisms of development, and response to basic treatment. The aim of present study was to analyze clinical and anamnestic data of patients with BA accompanied with obesity, focusing on the age of onset. Material and methods. A cohort of 195 patients with obesity associated bronchial asthma were examined. The obtained results were compared with the database of similar indeces of a control group consisted of 95 healthy individuals without allergies or atopy symptoms in their histories. All patients participating in the study signed an informed consent agreement. The patients were subdivided into two clinical groups based on the BA onset age. Group I included 100 patients with early-onset BA (early asthma phenotype), while group II comprised of 95 patients with late-onsetB A (late asthma phenotype). Analysis showed that there were no significant differences in gender and age between the clinical groups (p more than 0.05). The diagnosis of BA and the severity of the course were established according to the recommendations of GINA-2016 and its subsequent versions. ACQ-5 questionnaire was used to assess BA control. AQLQ was used to assess the quality of life of BA patients. The study was approved by the Bioethics Commission of the Educational and Scientific Medical Institute of Sumy State University. Statistical analysis of the obtained results was carried out using the SPSS-17 program. The results. No significant differences (p more than 0.05) were detected in age, sex, burdened heredity, and bone/muscle indeces between patients with obesity associated BA regarding the onset of the disease. However, patients with early-onset BA had longer disease duration compared with late-onset BA (p is equal to 0.001). It was also revealed a certain correlation between asthma flare-ups and seasonal and non-specific triggers depending on the age of onset. Namely, patients with early-onset obesity associated BA experienced exacerbation symptoms twice as often during the flowering period of plants, compared to those with late-onset asthma (p is equal to 0.001). Among the patients with BA, 90.5% of those with late-stage BA experienced more frequent exacerbations during the cold season compared to patients with early-stage BA. This difference was statistically significant (p is equal to 0.001) with the frequency being 1.7 times higher. Additionally, physical activity triggered exacerbations in every second patient with late-stage BA, while the same was observed in every third patient with early-stage BA (p is equal to 0.009). It was also revealed that patients with late onset BA experienced attacks requiring the use of salbutamol 2.4 times more often than those with early onset BA (p is equal to 0.001). This observation included a higher needs of salbutamol administration during the daytime (p is equal to 0.001). What concerns patients complaints and examination data, it was revealed that the incidence of shortness of breath, general weakness, and fatigue were similar between both group patients, while productive cough was 2.4 times more likely to occur in patients with late BA. No significant differences were detected in the indices of asthma control, as measured by the ACQ-5 questionnaire, and pulmonary function between both group patients. However the reversibility of bronchial obstruction was lower in patients with BA late-onset of (p is equal to 0.001). Conclusions. Based on the accomplished analysis of clinical and functional data it was revealed significant differences between the early and late-onset phenotypes of patients with obesity associated BA. In particular, patients with early-onset BA have longer disease duration, experience exacerbation due to plant flowering, exhibit more frequent morning symptoms and exacerbations, and require more intense systemic glucocorticoids administration. Distinctive features of late-onset BA included occupational hazards, the cold season acute respiratory viral infections, physical exertion, and combination of the above factors more oftenly caused exacerbation. Daytime symptoms with the need to take salbutamol, cough (including sputum), lower reversibility of bronchial obstruction, and indices of a lower quality of life were also characteristic for the late-onset obesity associated BA patients.