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Review
. 2023 Mar 8;32(167):220202.
doi: 10.1183/16000617.0202-2022. Print 2023 Mar 31.

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

Paola Rogliani  1 , Rossella Laitano  2 , Josuel Ora  2 , Richard Beasley  3 , Luigino Calzetta  4
Affiliations
Review

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

Paola Rogliani et al. Eur Respir Rev. .

Erratum in

Abstract

Background: The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma.

Methods: A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations via Cohen's d method. Cohen's d=0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's d >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657.

Results: Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's d >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's d >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test.

Conclusion: This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.

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Conflict of interest statement

Conflict of interest: P. Rogliani participated as a lecturer and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Mundipharma, and Novartis, and her department was funded by Almirall, Boehringer Ingelheim, Chiesi Farmaceutici Novartis, and Zambon, outside the submitted work. Conflict of interest: R. Laitano has nothing to disclose. Conflict of interest: J. Ora has nothing to disclose. Conflict of interest: R. Beasley reports grants and personal fees from AstraZeneca, grants from GlaxoSmithKline and Genentech, personal fees from Avillion and Theravance, outside the submitted work. Conflict of interest: L. Calzetta has participated as advisor in scientific meetings under the sponsorship of Boehringer Ingelheim and Novartis; received nonfinancial support from AstraZeneca; a research grant partially funded by Chiesi Farmaceutici, Boehringer Ingelheim, Novartis, and Almirall; is or has been a consultant to ABC Farmaceutici, Edmond Pharma, Zambon, Verona Pharma, and Ockham Biotech; and his department was funded by Almirall, Boehringer Ingelheim, Chiesi Farmaceutici, Novartis, and Zambon, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram for the identification of the studies included in the pairwise meta-analysis.
FIGURE 2
FIGURE 2
Analysis of the strength of association of specific a) psychiatric and neuronal disorders, b) respiratory disorders, c) allergic disorders and d) cardiovascular disorders with asthma.
FIGURE 3
FIGURE 3
Analysis of the strength of association of specific a) metabolic disorders, b) gastrointestinal disorders, c) musculoskeletal disorders and d) other disorders with asthma. GORD: gastro-oesophageal reflux disease.
FIGURE 4
FIGURE 4
Analysis of the strength of association of specific a) psychiatric and neurological disorders, b) respiratory and allergic disorders, c) cardiovascular disorders, d) metabolic disorders and e) other disorders with severe asthma.
See this image and copyright information in PMC

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