Predictors of accelerated decline in FEV1in a prospective new-onset asthma cohort

Rationale : There is increasing evidence that adult-onset asthma is associated with accelerated decline in FEV 1 . However, it is unknown which patients are at greatest risk. Aim : To identify risk factors for FEV 1 decline in new-onset asthma in adults. Methods : 200 adults with recently diagnosed ( 1 decline ≥275ml/5years (25 th quartile). Results : Sets of lung function data of 108 (54%) patients were available; 27 patients had a pbFEV 1 decline of ≥275ml/5years. At baseline, these patients had a lower BMI (26.4 vs. 29.0 kg/m 2 p=0.032), higher pbFEV 1 (106.9% vs 91.2% p=0.004), higher exhaled nitric oxide levels (FeNO)(22.0 vs 37.2 ppb p=0.035), higher sputum eosinophil9s (7.1% vs 0.4% p=0.017) and more patients had blood eosinophilia (≥0.3x109/L) (40% vs 14% p=0.002) compared to patients with pbFEV 1 decline 1 were independently associated with pbFEV 1 decline ≥275ml/5years. FeNO>50 ppb or blood eosinophilia gave an OR(95% CI) of 6.0 (2.1-17.6) and 5.6 (1.9-16.6), respectively. pbFEV 1 ≥100% gave an OR of 4.2 (1.4-12.3). Conclusion : Adults with newly diagnosed asthma with high FeNO or blood eosinophilia, and normal pbFEV 1 are at risk of accelerated decline in FEV 1 . This suggests that the adult-onset eosinophilic asthma phenotype has a poor prognosis.