COPD Identified as Most Common, Severe Comorbidity of Adult Asthma, Study Finds

Chronic obstructive pulmonary disease (COPD) was found to be the most common and severe comorbidity of adult asthma, followed by acute rhinosinusitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis (AD), allergic rhinitis, dysfunctional breathing, diabetes, pneumonia, sleep apnea, and gastroesophageal reflux disease.

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Asthma is a common chronic disease associated with lower life expectancy, and identifying and treating comorbidities has the potential to reduce the disease burden of asthma while reducing costs of care.

The population-based, matched cohort study aimed to examine the comorbidities associated with asthma in adults and the differences between the distribution of the identified diseases in people with asthma vs matched controls. The findings were published in BMJ Open Respiratory Research.

The study included a total of 1648 adults with asthma and 3310 adults without asthma, matched with age, gender, and area of residency. At the time of enrollment, all participants were aged between 30 to 93 years. Participants were followed between January 1, 1997, and December 31, 2013.

Participants were given a questionnaire which included baseline characteristics and follow-up information from the national discharge registry Finnish Institute for Health and Welfare. Data included information pertaining to diagnoses from outpatient care and day surgery of specialized health care, as well as data from inpatient care of specialized and primary health care. These data encompassed all main diagnoses that had at least 200 events and number of diagnoses based on their common appearance with adult asthma.

The researchers used Cox’s proportional hazards models stratified by the matching criteria. Additionally, the researchers adjusted for pack years and/or BMI to evaluate the matched and adjusted hazard ratios (HRs) for asthma among asthmatic and non-asthmatic groups.

The mean (SD) follow up time varied between 14.2 and 15.1 years, and the mean age at the time of enrollment was 53.9 years for those with asthma and 4.4 years for those without asthma. Of the total study population, 62% were women and 38% were men.

Patients with asthma were less likely to be never smokers, more likely to be ever smokers, and had higher incidences of obesity compared with those without asthma.

COPD was found to be significantly more common among patients with asthma (HR, 7.93; 95% CI, 5.24-12) compared with those without asthma. Additionally, patients with asthma had a 4-fold risk of acute rhinosinusitis, chronic rhinosinusitis with nasal polyps, AD, and vocal cord dysfunction, while pneumonia and chronic rhinosinusitis were 2.5 times more common among patients with asthma. Other comorbidities found to be twice as common among the asthmatic group were sleep apnea, gastroesophageal reflux disease, diabetes, allergic rhinitis, and dysfunctional breathing.

However, the researchers acknowledged some limitations to the study. First, the data used was based on clinical practice and diagnostic coding and may have varied between hospitals or physicians. Second, the use of systemic corticosteroid use and other pharmaceutical therapies for asthma may have acted as confounding factors, and no follow up data was available on medication use.

Despite these limitations, the researchers believe the identification of common and severe comorbidities associated with asthma is crucial when implementing strategies for better management of asthma.

Reference

Lemmetyinen RE, Toppila-Salmi SK, But A, et al. Comorbidities associated with adult asthma: a population-based matched cohort study in Finland. BMJ Open Respir Res. 2024;11(1):e001959. Published March 14, 2024. doi:10.1136/bmjresp-2023-001959