Non-atopic males with adult onset asthma are at risk of persistent airflow limitation

Background Patients with asthma have on average a more rapid decline in FEV1 as compared with the general population. Recent cluster analysis has revealed different asthma phenotypes that can be distinguished by age of onset and reversibility of airflow limitation. Objective This study aimed at detecting risk factors associated with persistent airflow limitation in patients with the adult onset asthma phenotype. Methods We recruited 88 patients with adult onset (>= 18 years) asthma from an academic pulmonary outpatient clinic in the Netherlands. The associations of age, age of asthma onset, asthma duration, gender, race, atopy, smoking packyears, BMI, use of oral corticosteroids with post-bronchodilator FEV1/FVC were investigated. Results Multiple linear regression analysis showed an association of absence of atopy (r = -0.27, B = -0.26, P = 0.01) and male gender (r = 0.31, B = 0.30, P = 0.004) with post-bronchodilator FEV1/FVC. Multiple logistic regression analysis showed that male patients were 10.8 (CI: 2.6-45.2) times the odds than women to have an FEV1/FVC < 0.7, and non-atopic patients were 5.2 (CI: 1.3-20.3) times the odds to have an FEV1/FVC < 0.7 than atopic patients. Conclusions and Clinical Relevance We conclude that in patients with adult onset asthma, male gender and absence of atopy are associated with persistent airflow limitation. This might suggest that amongst patients with adult onset asthma, non-atopic male patients are at increased risk of accelerated decline in lung function.