Prognostic factors of asthma severity: A 9-year international prospective cohort study

Roberto de Marco*, Alessandro Marcon, Deborah Jarvis, Simone Accordini, Enrique Almar, Massimiliano Bugiani, Adriana Carolei, Lucia Cazzoletti, Angelo Corsico, David Gislason, Amund Gulsvik, Rain Jõgi, Alessandra Marinoni, Jesús Martínez-Moratalla, Isabelle Pin, Christer Janson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

168 Citations (Scopus)


Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.

Original languageEnglish
Pages (from-to)1249-1256
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Issue number6
Publication statusPublished - Jun 2006
Externally publishedYes

Bibliographical note

Funding Information:
The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program.


  • Asthma
  • European Community Respiratory Health Survey
  • Global Initiative for Asthma (GINA) guidelines
  • IgE
  • asthma remission
  • body mass index
  • prognostic factors
  • prospective cohort study
  • severity


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