Severe asthma trajectories in adults: findings from the NORDSTAR cohort.

Background: There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with severe asthma.
Methods: We conducted an observational study based on Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified adult patients with severe asthma in 2018 according to the European Respiratory Society/American Thoracic Society definition and used latent class analysis to identify trajectories of asthma severity over a 10-year retrospective period from 2018.
Results: Among 169 128 asthma patients, we identified 4543 severe asthma patients. We identified four trajectories of severe asthma that were labelled as: trajectory 1 "consistently severe asthma" (n=389 (8.6%)), trajectory 2 "gradual onset severe asthma" (n=942 (20.7%)), trajectory 3 "intermittent severe asthma" (n=1685 (37.1%)) and trajectory 4 "sudden onset severe asthma" (n=1527 (33.6%)). "Consistently severe asthma" had a higher daily inhaled corticosteroid dose and more prevalent osteoporosis compared with the other trajectories. Patients with "gradual onset severe asthma" and "sudden onset severe asthma" developed type 2-related comorbidities concomitantly with development of severe asthma. In the latter group, this primarily occurred within 1-3 years preceding onset of severe asthma.
Conclusions: Four distinct trajectories of severe asthma were identified illustrating different patterns of progression of asthma severity. This may eventually enable the development of better preventive management strategies in severe asthma.
Competing Interests: Conflict of interest: A. von Bülow reports consulting fees from Novartis, speaker fees from Novartis, GSK and AstraZeneca, travel grants from AstraZeneca, and participation in advisory boards with AstraZeneca and Novartis. S. Hansen reports speaker fees from AstraZeneca. P. Sandin reports no conflicts of interest. O. Ernstsson reports no conflicts of interest. C. Janson reports no conflicts of interest. L. Lehtimäki reports fees for lectures, consultations or advisory board meetings from ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Mundipharma, Novartis, Orion and Sanofi. H. Kankaanranta reports consulting fees from AstraZeneca, GSK, Chiesi, MSD, Orion Pharma, Novartis and Sanofi-Genzyme, and speaker fees from AstraZeneca, GSK, Orion Pharma and Boehringer Ingelheim. C. Ulrik reports grants from Sanofi, Boehringer Ingelheim, AstraZeneca and Novartis, consulting fees from Chiesi, Orion Pharma, Menarini, Takeda, AstraZeneca, Teva and GSK, lecture fees from Orion, Pharma, AstraZeneca and Teva, and participation in advisory boards with Novartis, GSK, Pfizer, AstraZeneca, Sanofi, Chiesi and Boehringer Ingelheim. B.B. Aarli reports grants from Novartis, consulting fees from AstraZeneca, lecture fees from GSK, AstraZeneca, Sanofi-Aventis, Novartis and Boehringer Ingelheim, and participation in advisory boards with GSK, AstraZeneca, Chiesi Pharma, Novartis and Sanofi. K. Geale is a board member of Quantify Research AB, Quantify Research ApS, Quantify Research AS and Quantify HEOR Private Limited, is CEO of Quantify Research AB, Quantify Research ApS and Quantify Research AS, and has stock and stock options in Quantify Research AB. S.T. Tang is an employee at Sanofi and holds stocks in Sanofi. M. Wolf is an employee at Novartis Finland. V. Backer reports no conflicts of interest. O. Hilberg reports consulting fees from Novartis, Sanofi, AstraZeneca, GSK, ALK, MSD and Teva, and travel grants from Sanofi. A. Altraja reports consulting fees from AstraZeneca, Boehringer Ingelheim, GSK and Sanofi, speaker fees from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, Norameda (Chiesi), GSK, Sanofi and Zentiva, expert testimony for AstraZeneca, Boehringer Ingelheim, GSK and Sanofi, travel grants from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim and Norameda (Chiesi), participation in advisory boards with AstraZeneca, Boehringer Ingelheim, GSK and Sanofi, and receipt of equipment from Berlin-Chemie Menarini. H. Backman reports speaker fees from AstraZeneca, Boehringer Ingelheim and GSK. D. Lúdvíksdóttir reports speaker fees from GSK and Boehringer Ingelheim. U.S. Björnsdóttir reports speaker fees from Sanofi, AstraZeneca and Novartis, support for travel from Sanofi, and participation in advisory boards with Sanofi. P. Kauppi reports consulting fees from Sobi, speaker fees from GSK and AstraZeneca, and fee for PI for Theravance. T. Sandström reports no conflicts of interest. A. Sverrild reports grants from AstraZeneca, and speaker fees from AstraZeneca, Chiesi, GSK, Sanofi-Genzyme and Novartis. V. Yasinska reports lecture fees from GSK and Sanofi, and participation in advisory boards with AstraZeneca and GSK. M. Kilpeläinen reports no conflicts of interest. B. Dahlén reports grants from GSK and Novartis. A. Viinanen reports consulting fees from AstraZeneca and GSK, speaker fees from GSK and Chiesi, and travel grants from AstraZeneca and Sanofi. L. Bjermer reports speaker fees from AstraZeneca, GSK, Airsonette, Birc, Chiesi, Novartis and Sanofi, and participation in advisory boards with AstraZeneca, Chiesi, GSK, Birc and Sanofi. A. Bossios reports speaker fees from GSK, AstraZeneca, Teva and Novartis, travel grants from AstraZeneca and Novartis, participation in advisory boards with GSK, AstraZeneca, Teva, Novartis and Sanofi, is a member of the steering committee of SHARP, Secretary of Assembly 5 (Airway diseases, asthma, COPD and chronic cough) of the European Respiratory Society and is the vice-president of the Nordic Severe Asthma Network. C. Porsbjerg reports grants from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, consulting fees from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, lecture fees from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi and ALK, and participation in advisory boards with AstraZeneca, Novartis, Teva, Sanofi and ALK.
(Copyright ©The authors 2023.)