• W Gerald Teague, Brenda R Phillips, John V Fahy, Sally E Wenzel, Anne M Fitzpatrick, Wendy C Moore, Annette T Hastie, Eugene R Bleecker, Deborah A Meyers, Stephen P Peters, Mario Castro, Andrea M Coverstone, Leonard B Bacharier, Ngoc P Ly, Michael C Peters, Loren C Denlinger, Sima Ramratnam, Ronald L Sorkness, Benjamin M Gaston, Serpil C Erzurum, ComhairSuzy A ASAACleveland Clinic School of Medicine, Cleveland, Ohio., Ross E Myers, Joe Zein, Mark D DeBoer, Anne-Marie Irani, Elliot Israel, Bruce Levy, Juan Carlos Cardet, Wanda Phipatanakul, Jonathan M Gaffin, Fernando Holguin, Merritt L Fajt, Shean J Aujla, David T Mauger, and Nizar N Jarjour.
• University of Virginia School of Medicine, Charlottesville, Va. Electronic address: wgt2p@virginia.edu.
• J Allergy Clin Immunol Pract. 2018 Mar 1; 6 (2): 545-554.e4.

BackgroundThe effect of age on asthma severity is poorly understood.ObjectivesThe objective of this study was to compare the baseline features of severe and nonsevere asthma in the Severe Asthma Research Program (SARP) III cohort, and examine in cross section the effects of age on those features.MethodsSARP III is a National Institutes of Health/National Heart Lung Blood Institute multisite 3-year cohort study conducted to investigate mechanisms of severe asthma. The sample included 188 children (111 severe, 77 nonsevere) and 526 adults (313 severe, 213 nonsevere) characterized for demographic features, symptoms, health care utilization, lung function, and inflammatory markers compared by age and severity.ResultsCompared with children with nonsevere asthma, children with severe asthma had more symptoms and more historical exacerbations, but no difference in body weight, post-bronchodilator lung function, or inflammatory markers. After childhood, and increasing with age, the cohort had a higher proportion of women, less allergen sensitization, and overall fewer blood eosinophils. Enrollment of participants with severe asthma was highest in middle-aged adults, who were older, more obese, with greater airflow limitation and higher blood eosinophils, but less allergen sensitization than adults with nonsevere asthma.ConclusionsThe phenotypic features of asthma differ by severity and with advancing age. With advancing age, patients with severe asthma are more obese, have greater airflow limitation, less allergen sensitization, and variable type 2 inflammation. Novel mechanisms besides type 2 inflammatory pathways may inform the severe asthma phenotype with advancing age.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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