Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach

Abstract

Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.

Keywords: asthma; cardiovascular risk; cognitive impairment; eosinophils; immunodeficiencies; obesity; sickle cell disease; wheezing; α1-Antitrypsin deficiency.

Figure 1

Overview of different conditions potentially coexisting and interacting with bronchial asthma. Grey, thick arrows indicate a pathobiological contribution in the development of the disease; green, thin arrows highlight a negative impact on the disease control, burden and evolution. AATD: α1-Antitrypsin deficiency; ABPA: allergic bronchopulmonary aspergillosis; EGPA: eosinophilic granulomatosis with polyangiitis; CEP: Chronic Eosinophilic Pneumonia; CVD: cardiovascular Disease; HES: Hyper-eosinophilic Syndrome; SCD: Sickle Cell Disease.