title: Predictors for the development of progressive severity in new-onset adult asthma.
abstract: BACKGROUND
  A proportion of patients with adult-onset asthma have severe disease. Risk factors for an increase in asthma severity are poorly known.
  
  
  OBJECTIVE
  We sought to identify predictors for the development of severe asthma in adults.
  
  
  METHODS
  A cohort of 200 adults with new-onset asthma was prospectively followed for 2 years. At baseline, patients underwent a comprehensive assessment of clinical, functional, and inflammatory parameters. After 2 years, change in asthma severity was assessed by using the Global Initiative for Asthma score (range, 1-4), which is based on asthma control (Asthma Control Questionnaire), lung function (FEV1), and inhaled corticosteroid requirement. ANOVA and multiple regression equations were used in the analysis.
  
  
  RESULTS
  One hundred twenty-eight patients completed 2 years of follow-up. Seventeen (13.3%) patients had an increase in asthma severity, whereas 53 (41.4%) patients had a decrease. A lower postbronchodilator FEV1/forced vital capacity ratio and a higher number of cigarette pack years smoked at baseline were significantly associated with an increase in asthma severity at follow-up. Multiple regression equations showed that only the number of cigarette pack years smoked was independently associated with an increase in asthma severity, with an odds ratio of 1.4 (95% CI, 1.02-1.91) for every 10 pack years smoked.
  
  
  CONCLUSIONS
  A history of cigarette smoking in patients with new-onset adult asthma predicts an increase in asthma severity during the first 2 years of the disease in a dose-dependent manner.
authors: Department of Respiratory Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands. Electronic address: G.A.Westerhof@amc.uva.nl.
authors: Guus A
authors: GA
authors: Westerhof
authors: Department of Respiratory Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors: Elise M
authors: EM
authors: Vollema
authors: Department of Respiratory Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors: Els J
authors: EJ
authors: Weersink
authors: Department of Otorhinolaryngology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors: Susanne M
authors: SM
authors: Reinartz
authors: Department of Respiratory Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors: Selma B
authors: SB
authors: de Nijs
authors: Department of Respiratory Medicine, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors: Elisabeth H
authors: EH
authors: Bel
mesh_terms: D000328:Adult; D001249:Asthma / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Adult-onset asthma; asthma severity; new-onset asthma; predictors; prospective follow-up study; smoking