Asthma and respiratory comorbidities

Abstract

Asthma is a common respiratory condition with various phenotypes, nonspecific symptoms, and variable clinical course. The occurrence of other respiratory conditions with asthma, or respiratory comorbidities (RCs), is not unusual. A literature search of PubMed was performed for asthma and a variety of respiratory comorbidities for the years 2019 to 2024. The 5 conditions with the largest number of references, other than rhinitis and rhinosinusitis (addressed elsewhere), or that are the most problematic in the authors' clinical experience, are summarized. Others are briefly discussed. The diagnosis and treatment of both asthma and RCs are complicated by the overlap of symptoms and signs. Recognizing RCs is especially problematic in adult-onset, non-type 2 asthma because there are no biomarkers to assist in confirming non-type 2 asthma. Treatment decisions in subjects with suspected asthma and RCs are complicated by the potential similarities between the symptoms or signs of the RC and asthma, the absence of a sine quo non for the diagnosis of asthma, the likelihood that many RCs improve with systemic corticosteroid therapy, and the possibility that manifestations of the RCs are misattributed to asthma or vice versa. Recognition of RCs is critical to the effective management of asthma, particularly severe or difficult-to-treat asthma.

Keywords: Asthma; allergic bronchopulmonary aspergillosis; asthma–chronic obstructive pulmonary disease overlap; bronchiectasis; chronic obstructive lung disease; comorbid; cystic fibrosis; diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH); eosinophilic bronchitis; eosinophilic pneumonia; laryngeal dysfunction; obstructive sleep apnea; rhinitis; rhinosinusitis.