Adult asthma risk and antibiotics use are linked: there is a duration dependent relationship between asthma incidence and the cumulative use of antibiotics in adults aged 40 years and older, according to study findings published in BMJ Open Respiratory Research.

Researchers analyzed the link between adult asthma risk and antibiotics exposure with use of data from the National Health Insurance Service-Health Screening Cohort of Korean middle-aged to older-aged adults.

The main outcome was newly diagnosed cases of asthma between 2007 and 2019. Exposure variables were cumulative antibiotics prescription days and number of antibiotic classes from 2002 to 2006 that were defined individually in the database.

The analysis included 248,961 participants at least 40 years of age with health screening data from 2005 to 2006. The patients had a mean (SD) age of 55.43 (8.91) years and 57% were male. The cohort included 38,450 individuals who did not use antibiotics; individuals using antibiotics were divided as follows according to cumulative days of use: 1 to 14 days, n=112,068; 15 to 30 days, n=5494; 31 to 90 days, n=37,252; 91 or more days, n=4697. After a mean follow-up of 13 years, 42,452 participants were found to have asthma.

[U]sing antibiotics appropriately and responsibly with caution in clinical settings to prevent newly diagnosed asthma, particularly in adults, is necessary.

An increased risk for asthma was observed in individuals with 91 days or more of antibiotics exposure compared with individuals who did not use antibiotics (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.72-1.96), according to the adjusted multivariable Cox proportional hazards model (model 1). The multivariable Cox proportional hazard model that adjusted for infectious diseases (model 2) found an increased risk for asthma in individuals with 91 days or more of antibiotics exposure (aHR, 1.46; 95% CI, 1.38-1.55). A clear duration-dependent pattern between antibiotics use and asthma incidence occurred in both models (P <.001).

In model 1, individuals who used 4 or more antibiotic classes had an increased risk for asthma (aHR, 1.72; 95% CI, 1.65-1.80) compared with individuals who did not use antibiotics. In model 2, those who used 4 or more antibiotic classes also had an increased risk for asthma (aHR, 1.44; 95% CI, 1.39-1.49) compared with those who used 1 antibiotic class.

Asthma risk had an increasing trend among the overall stratified covariates as the cumulative days of antibiotic use increased (P <.001).

Among several limitations, data on air pollution, occupational risk, genetics, and family history were not available in the claims data. Also, bias due to reverse causation in patients with undiagnosed asthma may exist. Furthermore, confusing viral infections and asthma symptoms with antibiotic use may lead to missed cases in which antibiotics are incorrectly prescribed for asthma.

“Our results suggest that antibiotic use could possibly increase the risk of asthma in a duration-response relationship; therefore, using antibiotics appropriately and responsibly with caution in clinical settings to prevent newly diagnosed asthma, particularly in adults, is necessary,” concluded the study authors.

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