Characteristics of phenotype combinations in late-onset bronchial asthma

Bronchial asthma (BA) is a heterogeneous disease characterized by a diversity of clinical manifestations, pathophysiological mechanisms, inflammatory patterns, and responses to therapy. In recent years, increasing attention has been paid to late-onset asthma — a variant of the disease in which the first symptoms appear after the age of 40 years. Late-onset asthma is characterized by considerable clinical heterogeneity, frequent coexistence with comorbid conditions, and a variety of phenotypic and endotypic features that largely determine the course and prognosis of the disease. Objective. To study the clinical, functional, laboratory, and instrumental characteristics of different phenotypes of late-onset bronchial asthma, in order to clarify the features of the disease course and optimize a personalized approach to therapy. Material and methods. The study included 130 patients with a confirmed diagnosis of late-onset bronchial asthma who were hospitalized in a specialized pulmonology department. The diagnosis of BA was verified according to the Global Initiative for Asthma (GINA) criteria. Late onset was defined as the occurrence of first asthma symptoms after 40 years of age. Results and conclusion. Late-onset asthma is characterized by the coexistence of several phenotypes in a single patient. The accumulation of phenotypic traits (up to four) is associated with the most severe, uncontrolled disease course, marked decline in lung function, and enhanced eosinophilic inflammation, and may serve as a marker of poor prognosis. Identification of specific phenotypic combinations allows prediction of disease course and optimization of personalized therapy.