Asthma Exacerbations are Associated with a decline in Lung Function: A Longitudinal Population-Based Study

Seyi Soremekun, Liam G Heaney, Derek Skinner, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Naeimeh Hosseini, Nevaashni Eleangovan, Ruth B Murray, Trung N Tran, Benjamin Emmanuel, Esther Garcia Gil, Andrew Menzies-Gow, Matthew Peters, Njira Lugogo, Rupert Jones, David Price

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)
30 Downloads (Pure)


Rationale Progressive lung function (LF) decline in patients with asthma contribute to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however evidence is limited with mixed results.
Methods This historical cohort study of a broad asthma patient population in the Optimum Patient Care Research Database, examined asthma patients with 3+ eligible post-18th birthday peak expiratory flow rate (PEF) records (primary analysis), or records of forced expiratory flow in 1 second (FEV1) (sensitivity analysis). Adjusted linear growth models tested the association between mean annual exacerbation rate (AER) and lung function trajectory.
Results We studied 109,182 patients with follow-up ranging from 5-50 years, of which 75, 280 had data for all variables included in the adjusted analyses. For each additional exacerbation an estimated additional -1.34 L/min PEF per year (95% CI -1.23, -1.50) were lost. Patients with AERs >2/year and aged 18-24 years at baseline lost an additional -5.95 L/min PEF/year (95% CI -8.63, -3.28) compared to those with AER 0. These differences in the rate of LF decline between AER groups became progressively smaller as age at baseline increased. The results using FEV1 were consistent with the above.
Conclusion To our knowledge this study is the largest nationwide cohort of its kind and demonstrates that asthma exacerbations are associated with faster lung function decline. This was more prominent in younger patients, but was evident in older patients when it was related to lower starting lung function, suggesting a persistent deteriorating phenotype that develops in adulthood over time. Earlier intervention with appropriate management in younger asthma patients could be of value to prevent excessive lung function decline. 
Original languageEnglish
Pages (from-to)643-652
Number of pages10
Issue number7
Early online date3 Aug 2022
Publication statusPublished - 1 Jul 2023

Bibliographical note

This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
The authors thank the UK primary care sites that contributed anonymised patient data to this study; Drs Jaco Voorham and Marjan Kerkhof for their contributions to the preparation and analysis of the data; and Audrey Ang and Andrea Teh Xin Yi for coordinating logistical and administrative support for the development of this manuscript. We also thank our Thorax peer reviewers for their in-depth comments and suggestions which greatly improved the quality of this article.

Data Availability Statement

The dataset supporting the conclusions of this article was derived from the Optimum Patient Care Research Database ( The OPCRD has ethical approval from the National Health Service (NHS) Research Authority to hold and process anonymised research data (Research Ethics Committee reference: 15/EM/0150). This study was approved by the Anonymised Data Ethics Protocols and Transparency (ADEPT) committee – the independent scientific advisory committee for the OPCRD. The authors do not have permission to give public access to the study dataset; researchers may request access to OPCRD data for their own purposes. Access to OCPRD can be made via the OCPRD website ( or via the enquiries email


Dive into the research topics of 'Asthma Exacerbations are Associated with a decline in Lung Function: A Longitudinal Population-Based Study'. Together they form a unique fingerprint.

Cite this