Management of co-morbidities in asthma

Posted on: 31 Mar 2017
 

Module summary

This module highlights the importance of early recognition of comorbidities in patients with asthma.

Learning objectives

After completing the module, you should be able to:

• Describe the major comorbidities associated with asthma
• List common tests to identify and assess comorbidities
• Discuss how comorbidities can contribute to the pathogenesis and poor control of asthma
• Communicate the benefits of diagnosing and treating comorbidities in overall asthma management
• Define the key principles of treating difficult asthma, for instance when to make a specialist referral

Introduction

Patients with asthma frequently also have comorbidities, which can lead to poorer outcomes through misdiagnosis or misinterpretation of symptoms. The presence of these comorbidities can complicate asthma management.^1-3

For example, symptoms such as increased breathlessness may be misattributed to asthma when they are really caused by a coexistent condition. Some comorbid conditions can also alter the way in which asthma presents.

Misdiagnosis may occur, such as if a patient’s coexistent psychological condition causes them to incorrectly perceive their symptoms. Clearly, not correctly diagnosing comorbidities can result in inappropriate management of a patient’s asthma.^1,3-5

The prevalence of comorbidities may be higher in difficult asthma. This is defined by the BTS/SIGN 2016 asthma guideline as persistent symptoms and/or frequent asthma attacks. These occur despite treatment with high-dose therapies, including continuous or frequent use of oral steroids.⁶

Difficult asthma can markedly affect a patient’s quality of life. Patients experience frequent exacerbations that result in absence from work or school and may even be fatal. Difficult asthma increases the likelihood of hospital admission by 20 times and accounts for 50% of asthma-related expenditure.^5,7

As a result, BTS/SIGN recommend checking for comorbid conditions as part of the evaluation process in a patient with difficult asthma.⁶

List of abbreviations
ACOS	Asthma–COPD overlap  syndrome	ICS	Inhaled corticosteroid
BMI	Body mass index	LAMA	Long-acting muscarinic  antagonist
BTS/SIGN	British Thoracic Society/  Scottish Intercollegiate  Guidelines Network	OSA	Obstructive sleep apnoea
COPD	Chronic obstructive pulmonary  disease	PEF	Peak expiratory flow
CT	Computed topography	PPI	Proton pump inhibitor
ECG	Electrocardiogram	RCPH	Royal College of Paediatrics  and  Child Health
FEV1	Forced expiratory volume in 1  second	SABA	Short-acting beta agonist
GINA	Global Initiative for Asthma	TLCO	Transfer factor for carbon  monoxide
GORD	Gastro-oesophageal reflux  disease