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Original research
Association between asthma, corticosteroids and allostatic load biomarkers: a cross-sectional study
  1. Luke Evan Barry1,
  2. Ciaran O’Neill1,
  3. Liam G Heaney2
  1. 1 Centre for Public Health, Queen’s University Belfast, Belfast, UK
  2. 2 Centre for Infection and Immunity, Queen’s University Belfast, Belfast, UK
  1. Correspondence to Professor Liam G Heaney, Centre of Infection and Immunity, Queen's University Belfast, Belfast BT9 7BL, UK; l.heaney{at}


Background Allostatic load, a measure of early ageing or ‘wear and tear’ from adapting to environmental challenges, has been suggested as a framework with which to understand the stress-related disruption of multiple biological systems which may be linked to asthma. Considering the socioeconomic context is also critical given asthma and allostatic overload are more common in lower socioeconomic groups.

Aims Estimate the relationship between allostatic load and its constituent biomarkers, asthma and corticosteroid prescribing while controlling for socioeconomic status.

Methods Data from Understanding Society (a nationally representative survey of UK community-dwelling adults) waves 1–3 (2009–2012) allowed the identification of a sex-specific risk profile across 12 biomarkers used to construct an Allostatic Load Index for a sample of 9816 adults. Regression analyses were used to examine the association of asthma status and corticosteroid prescriptions with allostatic load and its constituent biomarkers while controlling for socioeconomic status (n=9805).

Results Subjects with currently treated asthma and no corticosteroid prescription have an allostatic load 1.21 times higher than those without asthma (p<0.001). Asthmatic subjects in receipt of inhaled corticosteroids had an allostatic load, approximately 1.12 times higher than those without asthma (p<0.001). This association persisted in sensitivity analyses and appeared to be driven by an association with specific biomarkers (dehydroepiandrosterone-sulfate, waist-to-height ratio and C-reactive protein).

Conclusion Early ageing, in the form of a higher allostatic load, was present even in the mildest asthma group not receiving inhaled corticosteroids. Allostatic load is helpful in understanding the increased all-cause mortality and multimorbidity observed in asthma.

  • asthma
  • health economist
  • asthma pharmacology
  • asthma epidemiology

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  • Contributors All authors designed the study and wrote the paper. LEB secured and analysed the data. LEB is the guarantor of this research. The corresponding author, LGH, attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and LGH reports grant funding from Medimmune, Novartis UK, Roche/Genentech, Astra Zeneca and GlaxoSmithKline, has taken part in Advisory Boards and given lectures at meetings supported by GlaxoSmithKline, Respivert, Merck Sharpe & Dohme, Nycomed, Boehringer Ingelheim, Novartis and Astra Zeneca. LGH has received support funding to attend International Respiratory meetings (Astra Zeneca, Chiesi, Novartis, Boehringer Ingelheim and GlaxoSmithKline) and has taken part in asthma clinical trials (GSK, Schering Plough, Synairgen and Roche/Genentech) for which his Institution was remunerated. LGH is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves Industrial Partnerships with Amgen, Johnson & Johnson, Genentech/Roche, Astra Zeneca/Medimmune, Aerocrine and Vitlograph. CON reports grants from AbbVie, Roche, Pfizer, and GSK outside the submitted work.

  • Patient and public involvement statement As this research was based on secondary analysis of a large national primary database, it was done without public/patient involvement.

  • Patient consent for publication Not required.

  • Ethics approval The University of Essex Ethics Committee has approved all data collection on Understanding Society main study and innovation panel waves, including asking consent for all data linkages except to health records. Requesting consent for health record linkage was approved at Wave 1 by the National Research Ethics Service (NRES) Oxfordshire REC A (08/H0604/124), at BHPS Wave 18 by the NRES Royal Free Hospital & Medical School (08/H0720/60) and at Wave 4 by NRES Southampton REC A (11/SC/0274). Approval for the collection of biosocial data by trained nurses in Waves 2 and 3 of the main survey was obtained from the National Research Ethics Service (Understanding Society—UK Household Longitudinal Study: A Biosocial Component, Oxfordshire A REC, Reference: 10/H0604/2).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. This database may be shared upon request to the UK Data Service (