Severe asthma across the adult lifespan: age-stratified outcome trajectories from the swiss severe asthma registry
Year: 2026
Type: article
Abstract: Introduction Age is an important determinant in severe asthma phenotypes, disease trajectories, and treatment response. However, longitudinal analyses of clinical outcomes stratified by age group across the full adult age spectrum remain largely absent from the literature. With the emergence of clinical remission as an additional treatment target, understanding whether remission is equally attainable across age groups in real-world practice has become clinically important. Methods This longitudinal analysis included 288 adult patients with severe asthma and complete data at baseline (V0), 12 months (V1), and 24 months (V2) from the Swiss Severe Asthma Registry (SSAR), an ongoing prospective cohort study. Patients were stratified into five age groups: 18–30, 31–50, 51–65, 66–75, and > 75 years. Individual remission components were: asthma control (ACT ≥ 20), preserved lung function (FEV1 > 80% predicted), freedom from maintenance oral corticosteroids (OCS), and absence of exacerbations, and were assessed at each timepoint. Four-criteria and three-criteria composite remission outcomes were defined and analysed longitudinally using generalised estimating equations (GEE), allowing comparison of remission trajectories across age groups over time. Results Consistent improvements in clinical outcomes were observed across all age groups over the 24-month observational period. Four-criteria composite remission rates approximately doubled from baseline to V2 across all groups, ranging from 18.5% to 37.5% at V2. No significant age group × time interactions were detected for any binary outcome or composite remission definition (all p > 0.05), indicating that trajectories of improvement did not differ significantly between age groups. Preserved lung function at baseline (lowest FEV1% predicted in the preceding two years) was the dominant predictor of four-criteria remission (OR 1.04, 95% CI 1.02–1.05, p < 0.001). Current biologic treatment was a consistent positive predictor across multiple outcomes, while switching biologic was a consistent negative predictor. Multimorbidity was an independent negative predictor of exacerbation freedom (OR 0.50, 95% CI 0.32–0.80, p = 0.003). Conclusion In this real-world cohort, current biologic treatment was a consistent independent positive predictor across multiple outcomes. Remission rates improved significantly over 24 months across all age groups, with no significant differences in remission trajectories between age groups after adjustment for relevant covariates. These findings support the conclusion that clinical remission is an attainable goal across the full adult age spectrum in severe asthma. Early treatment escalation before irreversible lung function impairment accumulates emerges as the most clinically actionable lever for improving remission attainment regardless of age. The independent negative association of multimorbidity with exacerbation freedom highlights the need for further research into the role of comorbidity management in optimising remission outcomes in severe asthma.
Source: Respiratory Research
Authors: Fabienne Jaun, Maria Boesing, Giorgia Lüthi-Corridori, Corinne Allgeier-Smith, Pierre-Olivier Bridevaux, Martin Brutsche, Florian Charbonnier, Christian Clarenbach, Jean-Marc Fellrath, Pietro Gianella, Anja Jochmann, Hans-Joachim Kabitz, Lukas Kern, Nikolay Pavlov, Esther Helen Steveling, Christophe von Garnier, Jörg D. Leuppi
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,490
OpenAlex ID: W7225833591
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