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.

Keywords: Age; Asthma; Asthma control; BMI; Comorbidities; Gender.

Fig. 1

The inflammatory cells and mediators in the pathogenesis of asthma (above) [3, 35], and the most frequently reported comorbid conditions (below) [–13]. COPD = chronic obstructive pulmonary disease

Fig. 2

The distribution of patients with cardiovascular disease (age trend 1, A), seasonal rhinitis (age trend 2, B) and gastroesophageal reflux disease (GERD) (age trend 3, C)

Fig. 3

Risk of having uncontrolled asthma if the given comorbidity is present

Fig. 4

Risk of having partially controlled asthma if the given comorbidity is present

Fig. 5

The frequency of specific comorbidities (prevalence of at least 10%) and the odds ratios of their relationship with uncontrolled (blue) and partially controlled (grey) asthma. The size of the bubbles represents the ratio of uncontrolled asthma (of all patients who suffer from that specific comorbidity). COPD = chronic obstructive pulmonary disease; CV = cardiovascular; DM = diabetes mellitus; GERD = gastroesophageal reflux disease; HT = hypertension; IFG = impaired fasting glucose; IHD = ischaemic heart disease; rhin. = rhinitis