Comorbidities in Severe Asthma: Frequency of Rhinitis, Nasal Polyposis, Gastroesophageal Reflux Disease, Vocal Cord Dysfunction and Bronchiectasis

Abstract

OBJECTIVESSevere asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD), nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma.METHODSWe conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis.RESULTSWe evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4%); 18 (7.3%) had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3%) had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6%) patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6%) patients. Vocal cord dysfunction was suspected in 16 (6.5%) and confirmed through laryngoscopy in 4 (1.6%). The patient records provided CT scans of the chest for 105 patients, and 26 (24.8%) showed bronchiectasis.DISCUSSIONRhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

Reflux, Allergic Rhinitis, and Sleep Disorders with Asthma Control and Quality of Life

“…Discussion There was negative correlation between AQLQ and RSI , and between ACT and RSI. These results are in accordance with the recent studies [3,5]. Cheung and his colleagues showed that, a significant proportion of asthmatic patients in Hong Kong have gastroesophageal reflux disease (GERD), and this is associated with poorer asthmatic control, quality of life, and psychological status [3].…”

“…Therefore, finding and elimination of these influencing factors are one of the priorities. There is a considerable evidence that, special medical conditions affect asthma managing, such as gastroesophageal reflux, allergic rhinitis, infections, surgery, obesity related comorbidities like obstructive sleep apnea [2][3][4][5][6]. Association of asthma with gastroesophageal reflux and allergic rhinitis is well known.…”

“…Global Initiative for Asthma (GINA) guideline reported that special consideration are required in managing asthma in relation to gastroesophageal reflux, rhinitis, sinusitis, respiratory infections, obesity and surgery [2]. In order to improve the treatment of patients with asthma and to control disease that is the main goal of therapy, comorbidities must be taken into consideration, and it is important to treat these conditions [5]. The better asthma control means the better quality of life, therefore, we aimed to investigate the effect of gastroesophageal reflux, allergic rhinitis, sleep disorders with asthma control and quality of life in Turkish asthma patients at a major University Hospital in Istanbul.…”

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…The prevalence of bronchiectasis in patients with severe asthma is relatively high; with 25–40% of patients having radiological signs of bronchiectasis [91,92], compared to 3% in a population of generally milder asthma [93]. …”

Avaliação dos artigos de pneumologia publicados em periódicos Brasileiros além do Jornal Brasileiro de Pneumologia

“…(3) In a review article, Giavina-Bianchi et al described the principal characteristics of difficult-to-control asthma and a protocol for its management. (4) Dalcin et al studied the prevalence of controlled asthma, partially controlled asthma, and uncontrolled asthma (56%, 27%, and 17%, respectively) and found that greater asthma severity, limited availability of medications, and no inhaled corticosteroid use were factors associated with poor disease control.…”