Adult-onset asthma becomes the dominant phenotype among women by age 40 years: The longitudinal CARDIA study

Akshay Sood*, Clifford Qualls, Mark Schuyler, Alexander Arynchyn, Jesse H. Alvarado, Lewis J Smith, David R. Jacobs

*Corresponding author for this work

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Rationale: Although asthma is usually considered to originate in childhood, adult-onset disease is being increasingly reported. Objectives:To contrast the proportion and natural history of adultonset versus pediatric-onset asthma in a community-based cohort. We hypothesized that asthma in women is predominantly of adult onset rather than of pediatric onset. Methods: This study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort in the United States over a 25-year period. Adult- and pediatric-onset asthma phenotypes were studied, as defined by age at onset of 18 years or older. Subjects with asthma were categorized by sex, obesity, atopy, smoking, and race by mean age/examination year, using a three-way analysis of covariance model. Natural history of disease was examined using probabilities derived from a Markov chain model. Measurements and Main Results: Asthma of adult onset became the dominant (i.e., exceeded 50%) phenotype in women by age 40 years. The age by which adult-onset asthma became the dominant phenotype was further lowered for obese, nonatopic, eversmoking, or white women. The prevalence trend with increasing time for adult-onset disease was greater among subjects with nonatopic than atopic asthma among both sexes. Furthermore, adult-onset asthma had remarkable sex-related differences in risk factors. In both sexes, the quiescent state for adult-onset asthma was less frequent and also "less stable" over time than for pediatric-onset asthma. Conclusions:Using a large national cohort, this study challenges the dictum that most asthma in adults originates in childhood. Studies of the differences between pediatric- andadult-onset asthmamay provide greater insight into the phenotypic heterogeneity of asthma.

Original languageEnglish (US)
Pages (from-to)188-197
Number of pages10
JournalAnnals of the American Thoracic Society
Volume10
Issue number3
DOIs
StatePublished - Jun 1 2013

Fingerprint

Young Adult
Coronary Vessels
Asthma
Phenotype
Pediatrics
Markov Chains
Natural History
Age of Onset
Sex Characteristics
Cohort Studies
Obesity
Smoking

Keywords

  • Adult-onset
  • Nonatopic
  • Obesity
  • Pediatric-onset
  • Recrudescent

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Sood, Akshay ; Qualls, Clifford ; Schuyler, Mark ; Arynchyn, Alexander ; Alvarado, Jesse H. ; Smith, Lewis J ; Jacobs, David R. / Adult-onset asthma becomes the dominant phenotype among women by age 40 years : The longitudinal CARDIA study. In: Annals of the American Thoracic Society. 2013 ; Vol. 10, No. 3. pp. 188-197.
@article{1c309a37c8f14b86b7d94d38ad238f63,
title = "Adult-onset asthma becomes the dominant phenotype among women by age 40 years: The longitudinal CARDIA study",
abstract = "Rationale: Although asthma is usually considered to originate in childhood, adult-onset disease is being increasingly reported. Objectives:To contrast the proportion and natural history of adultonset versus pediatric-onset asthma in a community-based cohort. We hypothesized that asthma in women is predominantly of adult onset rather than of pediatric onset. Methods: This study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort in the United States over a 25-year period. Adult- and pediatric-onset asthma phenotypes were studied, as defined by age at onset of 18 years or older. Subjects with asthma were categorized by sex, obesity, atopy, smoking, and race by mean age/examination year, using a three-way analysis of covariance model. Natural history of disease was examined using probabilities derived from a Markov chain model. Measurements and Main Results: Asthma of adult onset became the dominant (i.e., exceeded 50{\%}) phenotype in women by age 40 years. The age by which adult-onset asthma became the dominant phenotype was further lowered for obese, nonatopic, eversmoking, or white women. The prevalence trend with increasing time for adult-onset disease was greater among subjects with nonatopic than atopic asthma among both sexes. Furthermore, adult-onset asthma had remarkable sex-related differences in risk factors. In both sexes, the quiescent state for adult-onset asthma was less frequent and also {"}less stable{"} over time than for pediatric-onset asthma. Conclusions:Using a large national cohort, this study challenges the dictum that most asthma in adults originates in childhood. Studies of the differences between pediatric- andadult-onset asthmamay provide greater insight into the phenotypic heterogeneity of asthma.",
keywords = "Adult-onset, Nonatopic, Obesity, Pediatric-onset, Recrudescent",
author = "Akshay Sood and Clifford Qualls and Mark Schuyler and Alexander Arynchyn and Alvarado, {Jesse H.} and Smith, {Lewis J} and Jacobs, {David R.}",
year = "2013",
month = "6",
day = "1",
doi = "10.1513/AnnalsATS.201212-115OC",
language = "English (US)",
volume = "10",
pages = "188--197",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "3",

}

Adult-onset asthma becomes the dominant phenotype among women by age 40 years : The longitudinal CARDIA study. / Sood, Akshay; Qualls, Clifford; Schuyler, Mark; Arynchyn, Alexander; Alvarado, Jesse H.; Smith, Lewis J; Jacobs, David R.

In: Annals of the American Thoracic Society, Vol. 10, No. 3, 01.06.2013, p. 188-197.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adult-onset asthma becomes the dominant phenotype among women by age 40 years

T2 - The longitudinal CARDIA study

AU - Sood, Akshay

AU - Qualls, Clifford

AU - Schuyler, Mark

AU - Arynchyn, Alexander

AU - Alvarado, Jesse H.

AU - Smith, Lewis J

AU - Jacobs, David R.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Rationale: Although asthma is usually considered to originate in childhood, adult-onset disease is being increasingly reported. Objectives:To contrast the proportion and natural history of adultonset versus pediatric-onset asthma in a community-based cohort. We hypothesized that asthma in women is predominantly of adult onset rather than of pediatric onset. Methods: This study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort in the United States over a 25-year period. Adult- and pediatric-onset asthma phenotypes were studied, as defined by age at onset of 18 years or older. Subjects with asthma were categorized by sex, obesity, atopy, smoking, and race by mean age/examination year, using a three-way analysis of covariance model. Natural history of disease was examined using probabilities derived from a Markov chain model. Measurements and Main Results: Asthma of adult onset became the dominant (i.e., exceeded 50%) phenotype in women by age 40 years. The age by which adult-onset asthma became the dominant phenotype was further lowered for obese, nonatopic, eversmoking, or white women. The prevalence trend with increasing time for adult-onset disease was greater among subjects with nonatopic than atopic asthma among both sexes. Furthermore, adult-onset asthma had remarkable sex-related differences in risk factors. In both sexes, the quiescent state for adult-onset asthma was less frequent and also "less stable" over time than for pediatric-onset asthma. Conclusions:Using a large national cohort, this study challenges the dictum that most asthma in adults originates in childhood. Studies of the differences between pediatric- andadult-onset asthmamay provide greater insight into the phenotypic heterogeneity of asthma.

AB - Rationale: Although asthma is usually considered to originate in childhood, adult-onset disease is being increasingly reported. Objectives:To contrast the proportion and natural history of adultonset versus pediatric-onset asthma in a community-based cohort. We hypothesized that asthma in women is predominantly of adult onset rather than of pediatric onset. Methods: This study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort in the United States over a 25-year period. Adult- and pediatric-onset asthma phenotypes were studied, as defined by age at onset of 18 years or older. Subjects with asthma were categorized by sex, obesity, atopy, smoking, and race by mean age/examination year, using a three-way analysis of covariance model. Natural history of disease was examined using probabilities derived from a Markov chain model. Measurements and Main Results: Asthma of adult onset became the dominant (i.e., exceeded 50%) phenotype in women by age 40 years. The age by which adult-onset asthma became the dominant phenotype was further lowered for obese, nonatopic, eversmoking, or white women. The prevalence trend with increasing time for adult-onset disease was greater among subjects with nonatopic than atopic asthma among both sexes. Furthermore, adult-onset asthma had remarkable sex-related differences in risk factors. In both sexes, the quiescent state for adult-onset asthma was less frequent and also "less stable" over time than for pediatric-onset asthma. Conclusions:Using a large national cohort, this study challenges the dictum that most asthma in adults originates in childhood. Studies of the differences between pediatric- andadult-onset asthmamay provide greater insight into the phenotypic heterogeneity of asthma.

KW - Adult-onset

KW - Nonatopic

KW - Obesity

KW - Pediatric-onset

KW - Recrudescent

UR - http://www.scopus.com/inward/record.url?scp=84880870275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84880870275&partnerID=8YFLogxK

U2 - 10.1513/AnnalsATS.201212-115OC

DO - 10.1513/AnnalsATS.201212-115OC

M3 - Article

C2 - 23802814

AN - SCOPUS:84880870275

VL - 10

SP - 188

EP - 197

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 3

ER -