Prognosis
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020Long-term effects
Although it has been assumed that airway inflammation and airway remodelling have a cause and effect relationship, longitudinal evidence suggests that remodelling is an independent parallel process, unresponsive to anti-inflammatory medication such as inhaled corticosteroids. Longitudinal follow-up of childhood asthma into adulthood suggests that in some asthma patients, remodelling commences early in the disease process leading to fixed airflow obstruction. These cohort studies from general populations in Australia and New Zealand have reproducibly shown that in children with persistent asthma symptoms, most deficits in lung function growth have already occurred by 6 to 9 years of age, with a modest further effect of asthma on lung function thereafter.[137][138] This is consistent with adult data, where a longitudinal study of more than 9000 people found that asthmatic non-smokers had reduced forced expiratory volume at 1 second (FEV₁) at 19 years of age when compared with values in non-asthmatic non-smokers, and showed only minimal additional decrease thereafter.[139] This suggests that airway remodelling with irreversible airflow obstruction occurs early with persistent childhood asthma, but is a stable physiological phenotype thereafter. However, an accelerated decline in lung function has also been observed in chronic severe asthma, particularly in association with frequent and severe exacerbations.[140][141]
Life expectancy
The life expectancy of people with controlled asthma is similar to that for the general population.
Male sex, single marital status, and hypertension were found to be correlated with a higher risk of all-cause mortality in a Danish cohort study of adults with incident asthma.[142] Conversely, greater levels of self-reported physical activity were associated with a lower all-cause mortality risk.[142]
Remission
Highly effective anti-inflammatory disease-modifying anti-asthmatic drugs (infrequent inhaled corticosteroid [ICS], biologics, allergen immunotherapies) make the prospect of remission a viable treatment outcome.[143] A US consensus statement has proposed that patients meeting the following criteria over a 12-month period (including those receiving monoclonal antibody therapy) may be considered in remission:[144]
No exacerbations
No missed work or school
Stable and optimised pulmonary function results on ≥2 measurements
Continued use of controller therapies, only at low-medium dose of ICS, or less
Asthma Control Test >20, Asthma Impairment and Risk Questionnaire <2, or Asthma Control Questionnaire <0.75 on ≥2 measurements
Symptoms requiring one-time reliever therapy no more than once a month
This is a topic of ongoing debate.
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