Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

Data de publicação: 01/01/2024 Data Ahead of Print: 01/12/2023

Autores da FMUP

João De Almeida Lopes Da Fonseca

Autor

Participantes de fora da FMUP

Scelo, Ghislaine
Torres-Duque, Carlos A.
Maspero, Jorge
Tran, Trung N.
Murray, Ruth
Martin, Neil
Menzies-Gow, Andrew N.
Hew, Mark
Peters, Matthew J.
Gibson, Peter G.
Christoff, George C.
Popov, Todor A.
Cote, Andreanne
Bergeron, Celine
Dorscheid, Delbert
FitzGerald, J. Mark
Chapman, Kenneth R.
Boulet, Louis Philippe
Bhutani, Mohit
Sadatsafavi, Mohsen
Jimenez-Maldonado, Libardo
Duran-Silva, Mauricio
Rodriguez, Bellanid
Celis-Preciado, Carlos Andres
Cano-Rosales, Diana Jimena
Solarte, Ivan
Fernandez-Sanchez, Maria Jose
Parada-Tovar, Patricia
von Bulow, Anna
Bjerrum, Anne Sofie
Ulrik, Charlotte S.
Assing, Karin Dahl
Rasmussen, Linda Makowska
Hansen, Susanne
Altraja, Alan
Bourdin, Arnaud
Taille, Camille
Charriot, Jeremy
Roche, Nicolas
Papaioannou, I, Andriana
Kostikas, Konstantinos
Papadopoulos, Nikolaos G.
Salvi, Sundeep
Long, Deirdre
Mitchell, Patrick D.
Costello, Richard
Sirena, Concetta
Cardini, Cristina
Heffler, Enrico
Puggioni, Francesca
Canonica, Giorgio Walter
Guida, Giuseppe
Iwanaga, Takashi
Al-Ahmad, Mona
Linnemann, Desiree Larenas
Garcia, Ulises
Kuna, Piotr
Al-Lehebi, Riyad
Koh, Mariko Siyue
Rhee, Chin Kook
Cosio, Borja G.
de Llano, Luis Perez
Steve, Diahn-Warng Perng
Huang, Erick Wan-Chun
Wang, Hao-Chien
Tsai, Ming-Ju
Mahboub, Bassam
Salameh, Laila Ibraheem Jaber
Jackson, David
Busby, John
Heaney, Liam G.
Pfeffer, Paul
Goddard, Amanda Grippen
Wang, Eileen
Hoyte, Flavia
Wechsler, Michael E.
Chapman, Nicholas
Katial, Rohit
Carter, Victoria
Bulathsinhala, Lakmini
Eleangovan, Neva
Ariti, Con
Lyu, Juntao
Price, David B.
Porsbjerg, Celeste

Unidades de investigação

Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
Medicina da Comunidade, Informação e Decisão em Saúde
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) poten-tially type 2-related comorbidities, (2) potentially oral corticosteroid (OCS)-related comorbidities, or (3) comor-bidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2-related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbid-ities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater like-lihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepi-demiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121). (c) 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. This is an open access arti-cle under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Dados da publicação

ISSN/ISSNe:: 1534-4436, 1081-1206
Tipo:: Article
Páginas:: 42-53
DOI:: 10.1016/j.anai.2023.08.021

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Keywords

CO-MORBIDITIES; REVERSIBILITY; PREVALENCE