Abstract
BackgroundAccording to ATS/ERS document on severe asthma (SA), the management of these patients requires the identification and proper treatment of comorbidities, which can influence the control of asthma.MethodsThe aim of this study was to assess the independent effect of different comorbidities on clinical, functional and biologic features of SA. Seventy-two patients with SA according to GINA guidelines were examined. We collected demographic data, smoking habit, asthma history, and assessment of comorbidities. Pulmonary function, inflammatory biomarkers, upper airway disease evaluation, asthma control and quality of life were carefully assessed.ResultsThe mean age of patients was 59.1 years (65.3% female, 5.6% current smokers). Comorbidities with higher prevalence were: chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), obesity and gastro-esophageal reflux (GERD), with some overlapping among them. In an univariate analysis comparing patients with single comorbidities with the other ones, asthmatics with CRSwNP had lower lung function and higher sputum eosinophilia; obese asthmatics had worse asthma control and quality of life, and tended to have lower sputum eosinophils; asthmatics with GERD showed worse quality of life. In multivariate analysis, obesity was the only independent factor associated with poor asthma control (OR 4.9), while CRSwNP was the only independent factor associated with airway eosinophilia (OR 16.2). Lower lung function was associated with the male gender and longer duration of asthma (OR 3.9 and 5.1, respectively) and showed a trend for the association with nasal polyps (OR 2.9, p = 0.06).ConclusionOur study suggests that coexisting comorbidities are associated with different features of SA.
Highlights
Severe asthma (SA) represents a major problem in asthma management
The ERS/ATS document defined severe asthma (SA) as asthma which requires high level of inhaled therapy to be controlled or which remain uncontrolled despite that [4]. This definition includes a heterogeneous group of patients in whom the control of the disease is not achieved for different reasons [5], like a relative insensitivity to corticosteroid therapy or presence of factors other than asthma, like persistent environmental exposures, psychosocial issues and comorbidities, which cannot be completely removed or resolved
We collected for each patient demographic data, smoking habit, familiar history of asthma, age of asthma onset, anthropometric data (weight, height, body mass index (BMI)) for assess obesity (BMI ≥ 30), presence of gastroesophageal reflux disease (GERD) and other important comorbidities
Summary
Severe asthma (SA) represents a major problem in asthma management. severe asthma represents no more than 10% of all asthma patients, it is responsible for the large majority of direct and indirect costs for asthma [1, 2]. The ERS/ATS document defined SA as asthma which requires high level of inhaled therapy to be controlled or which remain uncontrolled despite that [4]. This definition includes a heterogeneous group of patients in whom the control of the disease is not achieved for different reasons [5], like a relative insensitivity to corticosteroid therapy (treatment-resistant SA) or presence of factors other than asthma, like persistent environmental exposures, psychosocial issues and comorbidities (difficult-to-treat SA), which cannot be completely removed or resolved. According to ATS/ERS document on severe asthma (SA), the management of these patients requires the identification and proper treatment of comorbidities, which can influence the control of asthma
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