Epidemiology of comorbidities and their association with asthma control

Abstract

Background The prevalence of comorbidities and their relation to asthma control and treatment is a topic of increasing interest, however comprehensive studies are scarce. We aimed to determine the prevalence of the most common comorbidities in asthma in relation to patient characteristics (age, gender and body mass index [BMI]) and their association with asthma control in a large, specialist-managed representative patient population. Methods A secondary, exploratory analysis of the Asthma Reality (ARL), across-sectional, non-interventional real-life study was conducted. Basic patient characteristics, the prevalence of comorbidities and data on asthma control and risk factors had been collected and their interactions examined. Descriptive statistics and binomial regression were used to assess the distribution of the prevalence of comorbidities and propensity matching was applied to assess their effect on asthma control. Results Overall, 12,743 patients were enrolled in our study in 187 treatment centres covering all regions of Hungary. Most comorbidities showed significantly different distribution for all basic patient characteristics. Gender, age group, smoking status, BMI and the duration of asthma had a significant impact on asthma control. The frequency of uncontrolled asthma was higher in females (37.1%), in the age group of 46–65 years (39.6%), in severely obese patients (43.2%), in patients who had been diagnosed with asthma for more than 20 years (40.4%), and in active heavy smokers (55%), compared with respective groups in the same category. Based on the binomial regression with propensity score matching, concomitant chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.80–2.36), ischaemic heart disease (OR = 1.86, 95% CI 1.64–2.10) and cerebrovascular events (OR = 1.85, 95% CI 1.47–2.32) had the strongest negative effect on asthma control, with the presence of all of these conditions increasing the risk of uncontrolled asthma. Conclusions This evaluation of comorbidity data of more than 12,000, adult asthmatic patients has provided a clearer picture of diseases that can frequently co-exist with asthma, and their influence on asthma control, assessed by the prevalence of symptoms. Our study suggests that most asthmatic patients have at least one comorbidity, and the presence of comorbidities may have a high impact on asthma control measures.

Strength of association between comorbidities and asthma: a meta-analysis

“…The association between asthma and cardiovascular diseases has been described in previous studies [89][90][91]. The strong association observed between hypertension and severe asthma could be in part related to systemic inflammation [92,93], although hypertension may be a steroid-induced complication related to the use of inhaled corticosteroids in asthma [13].…”

Budesonide/formoterol via the Elpenhaler® device in asthmatic patients: A real-world effectiveness study (The BOREAS Study)

“…These have been commonly reported in other studies, with various possible mechanisms being proposed as the link with asthma, including affected levels of inflammatory mediators, cellular stress, and mechanical anatomic effects [23][24][25][26][27] . Since multiple chronic conditions tend to occur concurrently, affect the patient's overall quality of life and exposure to healthcare services, and influence the severity of the disease, the management of asthma patients with comorbidities should be addressed as a whole 24,[27][28][29] .…”

Asthma and Tobacco Smoking

“…Furthermore, asthmatic smokers display greater prevalence of various comorbid conditions, according to published studies. These conditions include perennial rhinitis, seasonal rhinitis, lung cancer, coronary heart disease, arrhythmias, hypertension, diabetes mellitus, osteoporosis and prostate hyperplasia [ 82 , 83 ]. The presence of any of these comorbidities in a patient with asthma influences his overall health status, as well as the course of asthma, by means of directly damaging asthma control and potential drug interactions [ 83 ].…”

“…These conditions include perennial rhinitis, seasonal rhinitis, lung cancer, coronary heart disease, arrhythmias, hypertension, diabetes mellitus, osteoporosis and prostate hyperplasia [ 82 , 83 ]. The presence of any of these comorbidities in a patient with asthma influences his overall health status, as well as the course of asthma, by means of directly damaging asthma control and potential drug interactions [ 83 ]. Taking into account all of the aforementioned information, it does not come as a surprise that ever smokers with asthma have a worse quality of life than never smokers with asthma [ 18 ].…”