Asthma Exacerbations are Associated with a decline in Lung Function: A Longitudinal Population-Based Study

Seyi Soremekun, Liam G Heaney, Derek Skinner, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Naeimeh Hosseini, Nevaashni Eleangovan, Ruth B Murray, Trung N Tran, Benjamin Emmanuel, Esther Garcia Gil, Andrew Menzies-Gow, Matthew Peters, Njira Lugogo, Rupert Jones, David Price

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Rationale Progressive lung function (LF) decline in patients with asthma contribute to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however evidence is limited with mixed results.
Methods This historical cohort study of a broad asthma patient population in the Optimum Patient Care Research Database, examined asthma patients with 3+ eligible post-18th birthday peak expiratory flow rate (PEF) records (primary analysis), or records of forced expiratory flow in 1 second (FEV1) (sensitivity analysis). Adjusted linear growth models tested the association between mean annual exacerbation rate (AER) and lung function trajectory.
Results We studied 109,182 patients with follow-up ranging from 5-50 years, of which 75, 280 had data for all variables included in the adjusted analyses. For each additional exacerbation an estimated additional -1.34 L/min PEF per year (95% CI -1.23, -1.50) were lost. Patients with AERs >2/year and aged 18-24 years at baseline lost an additional -5.95 L/min PEF/year (95% CI -8.63, -3.28) compared to those with AER 0. These differences in the rate of LF decline between AER groups became progressively smaller as age at baseline increased. The results using FEV1 were consistent with the above.
Conclusion To our knowledge this study is the largest nationwide cohort of its kind and demonstrates that asthma exacerbations are associated with faster lung function decline. This was more prominent in younger patients, but was evident in older patients when it was related to lower starting lung function, suggesting a persistent deteriorating phenotype that develops in adulthood over time. Earlier intervention with appropriate management in younger asthma patients could be of value to prevent excessive lung function decline. 
Original languageEnglish
Early online date3 Aug 2022
Publication statusE-pub ahead of print - 3 Aug 2022


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