Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation
- 15 December 2017
- Vol. 73 (7), 1369-1382
- https://doi.org/10.1111/all.13370
Abstract
The care of patients with difficult-to-control asthma (“difficult asthma”) is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality. Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as “treatable traits” in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.Keywords
This publication has 191 references indexed in Scilit:
- Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory studyBMC Pulmonary Medicine, 2013
- Weight loss interventions for chronic asthmaCochrane Database of Systematic Reviews, 2012
- Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammationJournal of Allergy and Clinical Immunology, 2011
- Persistent asthma, comorbid conditions and the risk of work disability: a prospective cohort studyAllergy, 2011
- Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategiesInternational Journal of Psychophysiology, 2010
- Effects of Asymptomatic Proximal and Distal Gastroesophageal Reflux on Asthma SeverityAmerican Journal of Respiratory and Critical Care Medicine, 2009
- Efficacy of Esomeprazole for Treatment of Poorly Controlled AsthmaNew England Journal of Medicine, 2009
- Risk factors for death in adults with severe asthmaAnnals of Allergy, Asthma & Immunology, 2008
- Sleep apnea: A proinflammatory disorder that coaggregates with obesityJournal of Allergy and Clinical Immunology, 2008
- Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research ProgramJournal of Allergy and Clinical Immunology, 2007