Long-Term Remission And Changes In The Severity Of Asthma Over 30 Years-Trail Cohort

Background and Objective: Observations from long-term follow-up studies of well-characterised asthma in adults are sparse. We aimed to illuminate long-term remission and change in disease severity over three decades. Methods: We examined 125 persons (of 621 invited) with an objectively verified diagnosis of asthma between 1974-1990 at the Frederiksberg Respiratory and Allergy clinic. Participants (age range 44-88 years) completed questionnaires, pulmonary function tests and blood tests in a follow-up visit 2017-2019. Based on these assessments, participants were classified as having either active asthma, clinical remission or complete remission. Additionally, change in disease severity was determined based on GINA symptom control and level of prescribed asthma medication. Results: We found that 25% had clinical remission (no symptoms or prescribed asthma medication within the last year) and 15% had complete remission (FeNO <50, no bronchodilator reversibility, no airway hyperresponsiveness and no airflow limitation). We found that longer time since symptom debut before baseline visit to be associated with lower odds for asthma remission (OR 0.88, 95% CI 0.783—0.995, p = <0.05). At follow-up, 31% had well-controlled asthma compared to none at baseline. Furthermore, lower FEV1/FVC ratio and older age at baseline were predictors of uncontrolled asthma at follow-up. High blood eosinophils (≥ 0.30 mmol/l) and prescribed ICS at baseline were predictors of medium/high dose ICS at the follow-up visit. Conclusion: Our findings show that asthma is a disease that rarely remits in adults. Symptom control is better overall, yet only 31% had well-controlled disease 30+ years after asthma diagnosis.