Comorbidities in difficult asthma are independent risk factors for frequent exacerbations, poor control and diminished quality of life

Tay, Tunn Ren; Radhakrishna, Naghmeh; Hore‐Lacy, Fiona; Smith, Catherine L.; Hoy, Ryan; Dabscheck, Eli; Hew, Mark

doi:10.1111/resp.12838

Cited by 158 publications

(151 citation statements)

References 39 publications

(53 reference statements)

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“…Co-morbidities are a common feature of severe asthma, which may contribute to poor symptom control [59]. Conversely, co-morbidities may be caused by severe asthma; steroid treatment is associated with an increased risk of iatrogenic co-morbidities including obesity, osteoporosis, diabetes, depression, and gastrointestinal reflux [1,60,61](Table 2).…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

“…Allergic rhinitis is common in asthma in general, and seems to play a more important role in early onset severe asthma, whereas in late-onset, severe asthma, allergy generally seems to have less clinical impact [59]. …”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

“…GERD is associated with poor symptom control, as well as more frequent exacerbations in severe asthma [59,88]. Although the causal link is unclear, co-existence of gastroesophageal reflux is very common in patients with asthma [89].…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

See 2 more Smart Citations

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

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

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

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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“…Thus, asthma is also a common condition, responsible for considerable morbidity, healthcare utilization and costs, which include those costs caused by the days off work and decrease productivity of patients with uncontrolled asthma [6,7]. Asthma is also characterized by the presence of comorbidities which substantially affect the quality of life and the number of exacerbations [8].…”

Section: Introductionmentioning

confidence: 99%

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions

et al. 2017

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Chronic obstructive pulmonary disease and asthma are the most frequent chronic respiratory diseases that affect the general population. For a long period of time these two conditions were considered to be separate diseases. However, it became evident that some patients share symptoms and clinical findings from both diseases. These patients are considered to represent a distinct phenotype, called asthma-COPD overlap syndrome (ACOS). However, since approximately the one third of the asthmatics smoke the ACOS may primarily define those patients. This is a relatively newly defined clinical syndrome whose underlying mechanisms and most appropriate management remain to be confirmed. In this review, we summarize current knowledge on this syndrome, aiming to update clinicians and help their daily practice.

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“…Increasing evidence indicate that the presence of comorbidities can influence asthma control and asthma outcomes (3). Obstructive sleep apnea (OSA), one of the most common comorbidities, is associated with the occurrence of asthma, poor asthma control, frequent exacerbations and asthma-related quality of life (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Screening for obstructive sleep apnea syndrome in asthma patients: a prospective study based on Berlin and STOP-Bang questionnaires

Lu¹,

Fu²,

Li³

et al. 2017

J. Thorac. Dis.

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Background: The bidirectional relationship of asthma and obstructive sleep apnea (OSA) has been confirmed in recent years. However, in the clinical practice, majority of asthma patients did not pay adequate attention to their sleep apnea condition. Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) are two most common OSA screening questionnaires to screen high-risk patients for OSA. This study aimed at evaluating the predictive performance of BQ and SBQ for OSA in asthma patients.Methods: Asthma outpatients of Zhongshan Hospital were enrolled into the study. All patients were asked to fill in the BQ and SBQ and clinical characteristics and asthma characteristics were recorded. Univariate and multivariate logistic regression analyses were applied to identify risk factors of OSA in asthma patients.With the gold standard of laboratory-based overnight polysomnography (PSG), the predictive performance of SBQ and BQ was evaluated and compared. The probability of OSA severity was predicted by various SBQ scores in asthma patients.Results: A total of 123 asthma patients (average age 47.56±12.12 years; 57.72% males) were enrolled and underwent PSG diagnosis overnight at Sleep Center. Logistic regression analyses showed that rhinitis (adjusted OR =4.30; 95% CI: 1.50-12.37, P=0.007) and dyslipidemia (adjusted OR =2.75; 95% CI: 1.16-6.51, P=0.021) were associated with OSA in asthma patients after adjusting for known OSA risk factors. No asthma functional characteristic differences were found to be associated with OSA severity in the study. The prevalence of moderate-to-severe OSA (AHI ≥15) in the asthmatic population sample was 36.59% (45/123).Questionnaires predictive results showed that compared with BQ, SBQ has higher diagnostic sensitivity (84.4% vs. 60%), lower specificity (79.5% vs. 91%) lower positive predictive value (PPV): (70.4% vs. 79.4%) and higher negative predictive value (NPV) (90% vs. 80%) to detect moderate-to-severe OSA at the cutoff as AHI of 15/h. OSA probability results showed that with the increasing of the questionnaire scores, the moderate and severe OSA probability of SBQ rose significantly.Conclusions: SBQ is a preferable sleep questionnaire better than BQ for detecting moderate and severe OSA in asthma patients which should be validated in larger population sample.

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Comorbidities in difficult asthma are independent risk factors for frequent exacerbations, poor control and diminished quality of life

Cited by 158 publications

References 39 publications

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

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

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions

Screening for obstructive sleep apnea syndrome in asthma patients: a prospective study based on Berlin and STOP-Bang questionnaires

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