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Severe asthma trajectories in adults: findings from the NORDSTAR cohort

Anna von Bülow, Susanne Hansen, Patrik Sandin, Olivia Ernstsson, Christer Janson, Lauri Lehtimäki, Hannu Kankaanranta, Charlotte Ulrik, Bernt Bøgvald Aarli, Kirk Geale, Sheila Tuyet Tang, Maija Wolf, Vibeke Backer, Ole Hilberg, Alan Altraja, Helena Backman, Dóra Lúdvíksdóttir, Unnur Steina Björnsdóttir, Paula Kauppi, Thomas Sandström, Asger Sverrild, Valentyna Yasinska, Maritta Kilpeläinen, Barbro Dahlén, Arja Viinanen, Leif Bjermer, Apostolos Bossios, Celeste Porsbjerg
European Respiratory Journal 2023; DOI: 10.1183/13993003.02474-2022
Anna von Bülow
1Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
29shared first authorship
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Susanne Hansen
1Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
2Centre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
29shared first authorship
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Patrik Sandin
3Quantify Research, Stockholm, Sweden
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Olivia Ernstsson
3Quantify Research, Stockholm, Sweden
4Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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  • ORCID record for Olivia Ernstsson
Christer Janson
5Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Lauri Lehtimäki
1Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
6Allergy Centre, Tampere University Hospital, Tampere, Finland
7Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Hannu Kankaanranta
7Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
8Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
9Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Charlotte Ulrik
10Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Copenhagen University Hospital–Hvidovre, Hvidovre, Denmark
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Bernt Bøgvald Aarli
11Department of Clinical Science, University of Bergen, Bergen, Norway
12Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Kirk Geale
3Quantify Research, Stockholm, Sweden
13Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Sheila Tuyet Tang
14Sanofi, Copenhagen, Denmark
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Maija Wolf
15Novartis Finland, Espoo, Finland
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Vibeke Backer
16Department of Otorhinolaryngology Head & Neck surgery and Audiology, Rigshospitalet, Kobenhavn, Denmark
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Ole Hilberg
17Department of Medicine, Vejle Hospital, Vejle, Denmark
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Alan Altraja
18Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
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Helena Backman
19Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
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  • ORCID record for Helena Backman
Dóra Lúdvíksdóttir
20Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland & University of Iceland, Reykjavik, Iceland
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Unnur Steina Björnsdóttir
21Department of Respiratory Medicine and Allergy, Landspitali University Hospital, Reykjavik, Iceland
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Paula Kauppi
22Heart and Lung Center, Department of Pulmonary Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Thomas Sandström
13Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Asger Sverrild
1Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
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Valentyna Yasinska
23Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
24Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Maritta Kilpeläinen
25Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
26Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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Barbro Dahlén
23Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
24Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Arja Viinanen
25Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
26Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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Leif Bjermer
27Department of Respiratory Medicine & Allergology, Skane University Hospital, Lund, Sweden
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Apostolos Bossios
23Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
24Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
28Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Celeste Porsbjerg
1Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
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  • For correspondence: celeste.porsbjerg@regionh.dk
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Abstract

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.

Aim: 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 ERS/ATS definition and used latent class analysis (LCA) to identify trajectories of asthma severity over a ten-year retrospective period from 2018.

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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: The work was financially supported by Novartis and Sanofi & Regeneron Pharmaceuticals.

Conflict of interest: Anna von Bülow reports consulting fees from Novartis, speaker fees from Novartis, GSK, AstraZeneca, travel grants from AstraZeneca, participation in advisory boards with AstraZeneca, Novartis;

Conflict of interest: Susanne Hansen reports speaker fees from AstraZeneca;

Conflict of interest: Patrik Sandin has no conflicts of interest;

Conflict of interest: Olivia Ernstsson has no conflicts of interest;

Conflict of interest: Christer Janson reports no conflicts of interest;

Conflict of interest: Lauri Lehtimäki reports fees for lectures, consultations or advisory board meetings from ALK, Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Mundipharma, Novartis, Orion and Sanofi;;

Conflict of interest: Hannu Kankaanranta reports consulting fees from AstraZeneca, GSK, Chiesi, MSD, Orion Pharma, Novartis, SanofiGenzyme and speaker fees from AstraZeneca, GSK, Orion Pharma, Boehringer-Ingelheim;

Conflict of interest: Charlotte Ulrik reports grants from Sanofi, Boehringer Ingelheim, AstraZeneca, Novartis, consulting fees from Chiesi, Orion Pharma, Menarini, Takeda, AstraZeneca, TEVA, GSK, lecture fees from Orion, Pharma, AZ, TEVA, and participation in advisory boards with Novartis, GSK, Pfizer, AstraZeneca, Sanofi, Chiesi, Boehringer Ingelheim;

Conflict of interest: Bernt Bøgvald Aarli reports grants from Novartis, consulting fees from AstraZeneca, lecture fees from GSK, AstraZeneca, Sanofi-Aventis, Novartis, Boehringer Ingelheim, participation in advisory boards with GSK, Astra Zeneca, Chiesi Pharma, Novartis and Sanofi;

Conflict of interest: Kirk Geale is a board member of Quantify Research AB, Quantify Research ApS, Quantify Research AS, Quantify HEOR Private Limited, is CEO of Quantify Research AB, Quantify Research ApS, Quantify Research AS and has stock and stock options in Quantify Research AB;

Conflict of interest: Sheila Tuyet Tang is an employee at Sanofi and holds stocks in Sanofi;

Conflict of interest: Maija Wolf is an employee at Novartis Finland;

Conflict of interest: Vibeke Backer reports no conflicts of interest;

Conflict of interest: Ole Hilberg reports consulting fees from Novartis, Sanofi, AstraZeneca, GSK, ALK, MSD, Teva and travel grants from Sanofi;

Conflict of interest: Alan Altraja reports consulting fees from AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, speaker fees from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, Norameda (Chiesi), GSK, Sanofi, Zentiva, expert testimony from AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, travel grants from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, Norameda (Chiesi), participation in advisory boards with AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, and receipt of equipment from Berlin-Chemie Menarini;

Conflict of interest: Helena Backman reports speaker fees from AstraZeneca, Boehringer Ingelheim, GSK;

Conflict of interest: Dora Ludviksdottir reports speaker fees from GSK and Boeringer-Ingelheim;

Conflict of interest: Unnur Björnsdottir reports speaker fees from Sanofi, AstraZeneca, Novartis, support for travel from Sanofi, participation in advisory boards with Sanofi;

Conflict of interest: Paula Kauppi reports consulting fees from Sobi, speaker fees from GSK, AstraZeneca, and fee for PI for Theravance;

Conflict of interest: Thomas Sandström reports no conflicts of interest;

Conflict of interest: Asger Sverrild reports grants from AstraZeneca, speaker fees from AstraZeneca, Chiesi, GSK, Sanofi-Genzymes, Novartis;

Conflict of interest: Valentyna Yasinska reports lecture fees from GSK, Sanofi, participation in advisory boards with AstraZeneca and GSK;

Conflict of interest: Maritta Kilpeläinen reports no conflicts of interest;

Conflict of interest: Barbro Dahlén reports grants from GSK and Novartis;

Conflict of interest: Arja Viinanen reports consulting fees from AstraZeneca, GSK, speaker fees from GSK, Chiesi, travel grants from AstraZeneca, Sanofi;

Conflict of interest: Leif Bjermer reports speaker fees from AstraZeneca, GSK, Airsonette, Birc, Chiesi, Novartis, Sanofi and participation in advisory boards with AstraZeneca, Chiesi, GSK, Birc, Sanofi;

Conflict of interest: Apostolos Bossios reports speaker fees from GSK, AstraZeneca, Teva, Novartis, travel grants from AstraZeneca, Novartis, participation in advisory boards with GSK, AstraZeneca, Teva, Novartis, Sanofi, is a member of the steering committee of SHARP, Secretary of Assembly 5 (Airway diseases, asthma, COPD, and chronic cough) in the European Respiratory Society and is the vice-president of the Nordic Severe Asthma Network;

Conflict of interest: Celeste Porsbjerg reports grants from AstraZeneca, GSK, Novartis, Teva, Sanofi, Chiesi, ALK, consulting fees from AZ, GSK, Novartis, TEVA, Sanofi, Chiesi, ALK, lecture fees from AZ, GSK, Novartis, TEVA, Sanofi, Chiesi, ALK, participation in advisory boards with AstraZeneca, Novartis, TEVA, Sanofi, ALK.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received December 23, 2022.
  • Accepted July 3, 2023.
  • Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org
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Severe asthma trajectories in adults: findings from the NORDSTAR cohort
Anna von Bülow, Susanne Hansen, Patrik Sandin, Olivia Ernstsson, Christer Janson, Lauri Lehtimäki, Hannu Kankaanranta, Charlotte Ulrik, Bernt Bøgvald Aarli, Kirk Geale, Sheila Tuyet Tang, Maija Wolf, Vibeke Backer, Ole Hilberg, Alan Altraja, Helena Backman, Dóra Lúdvíksdóttir, Unnur Steina Björnsdóttir, Paula Kauppi, Thomas Sandström, Asger Sverrild, Valentyna Yasinska, Maritta Kilpeläinen, Barbro Dahlén, Arja Viinanen, Leif Bjermer, Apostolos Bossios, Celeste Porsbjerg
European Respiratory Journal Jan 2023, 2202474; DOI: 10.1183/13993003.02474-2022

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Severe asthma trajectories in adults: findings from the NORDSTAR cohort
Anna von Bülow, Susanne Hansen, Patrik Sandin, Olivia Ernstsson, Christer Janson, Lauri Lehtimäki, Hannu Kankaanranta, Charlotte Ulrik, Bernt Bøgvald Aarli, Kirk Geale, Sheila Tuyet Tang, Maija Wolf, Vibeke Backer, Ole Hilberg, Alan Altraja, Helena Backman, Dóra Lúdvíksdóttir, Unnur Steina Björnsdóttir, Paula Kauppi, Thomas Sandström, Asger Sverrild, Valentyna Yasinska, Maritta Kilpeläinen, Barbro Dahlén, Arja Viinanen, Leif Bjermer, Apostolos Bossios, Celeste Porsbjerg
European Respiratory Journal Jan 2023, 2202474; DOI: 10.1183/13993003.02474-2022
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