TY - JOUR
T1 - Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry
AU - Scelo, Ghislaine
AU - Torres-Duque, Carlos A.
AU - Maspero, Jorge
AU - Tran, Trung N.
AU - Murray, Ruth
AU - Martin, Neil
AU - Menzies-Gow, Andrew N.
AU - Hew, Mark
AU - Peters, Matthew J.
AU - Gibson, Peter G.
AU - Christoff, George C.
AU - Popov, Todor A.
AU - Côté, Andréanne
AU - Bergeron, Celine
AU - Dorscheid, Delbert
AU - FitzGerald, J. Mark
AU - Chapman, Kenneth R.
AU - Boulet, Louis Philippe
AU - Bhutani, Mohit
AU - Sadatsafavi, Mohsen
AU - Jiménez-Maldonado, Libardo
AU - Duran-Silva, Mauricio
AU - Rodriguez, Bellanid
AU - Celis-Preciado, Carlos Andres
AU - Cano-Rosales, Diana Jimena
AU - Solarte, Ivan
AU - Fernandez-Sanchez, Maria Jose
AU - Parada-Tovar, Patricia
AU - von Bülow, Anna
AU - Bjerrum, Anne Sofie
AU - Ulrik, Charlotte S.
AU - Assing, Karin Dahl
AU - Rasmussen, Linda Makowska
AU - Hansen, Susanne
AU - Altraja, Alan
AU - Bourdin, Arnaud
AU - Taille, Camille
AU - Charriot, Jeremy
AU - Roche, Nicolas
AU - Papaioannou, Andriana I.
AU - Kostikas, Konstantinos
AU - Papadopoulos, Nikolaos G.
AU - Salvi, Sundeep
AU - Long, Deirdre
AU - Mitchell, Patrick D.
AU - Costello, Richard
AU - Sirena, Concetta
AU - Cardini, Cristina
AU - Heffler, Enrico
AU - Puggioni, Francesca
AU - Canonica, Giorgio Walter
AU - Guida, Giuseppe
AU - Iwanaga, Takashi
AU - Al-Ahmad, Mona
AU - Linnemann, Désirée Larenas
AU - Garcia, Ulises
AU - Kuna, Piotr
AU - Fonseca, João A.
AU - Al-Lehebi, Riyad
AU - Koh, Mariko Siyue
AU - Rhee, Chin Kook
AU - Cosio, Borja G.
AU - de Llano, Luis Perez
AU - Perng (Steve), Diahn Warng
AU - Huang, Erick Wan Chun
AU - Wang, Hao Chien
AU - Tsai, Ming Ju
AU - Mahboub, Bassam
AU - Salameh, Laila Ibraheem Jaber
AU - Jackson, David
AU - Busby, John
AU - Heaney, Liam G.
AU - Pfeffer, Paul
AU - Goddard, Amanda Grippen
AU - Wang, Eileen
AU - Hoyte, Flavia
AU - Wechsler, Michael E.
AU - Chapman, Nicholas
AU - Katial, Rohit
AU - Carter, Victoria
AU - Bulathsinhala, Lakmini
AU - Eleangovan, Neva
AU - Ariti, Con
AU - Lyu, Juntao
AU - Price, David B.
AU - Porsbjerg, Celeste
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2024/1
Y1 - 2024/1
N2 - Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).
AB - Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).
UR - https://www.scopus.com/pages/publications/85174415775
U2 - 10.1016/j.anai.2023.08.021
DO - 10.1016/j.anai.2023.08.021
M3 - Article
C2 - 37640263
AN - SCOPUS:85174415775
SN - 1081-1206
VL - 132
SP - 42
EP - 53
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
IS - 1
ER -
SDG 3 Good Health and Well-being