About asthma and associated comorbidities

Comorbidity

Some people with asthma have other chronic diseases and long-term conditions. These are referred to as comorbidities—two or more health problems present at the same time. For people with asthma, having a comorbid chronic condition can have important implications for their health outcomes, quality of life and treatment choices.

The chance of developing chronic conditions increases with age, and since asthma often starts early in life, people with asthma are likely to develop another chronic condition during their lifespan. For example, in 2014–15, an estimated 90% of people aged 65 and over with asthma also had one or more additional chronic conditions, compared to 41% for people aged 0–44 and 77% for people aged 45–64, based on self-reported data [1].

Asthma in adults is associated with obesity, mental disorders, arthritis and cardiovascular disease [2, 3].

The chronic conditions that have been selected for this analysis are: cardiovascular disease, back problems, mental health problems, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and cancer. They have been selected because they are common in the general community and cause significant burden.

Other chronic conditions that are commonly found in people with asthma, and that can impact on asthma, include allergic rhinitis, obesity, obstructive sleep apnoea, respiratory infections and gastro-oesophageal reflux disease [4].

Having a history of asthma is a major risk factor for being diagnosed with COPD, particularly for smokers [5, 6]. At least 15–20% of people with asthma also have features consistent with COPD; this is often called asthma–COPD overlap or asthma–COPD overlap syndrome (ACOS) [7, 8]. Due to this overlap, it can be difficult to make an accurate diagnosis of these conditions.

Treatment and management

Management of asthma includes medicines to minimise symptoms such as shortness of breath, wheezing and coughing, and to reduce the risk of adverse outcomes, such as flare-ups.

Treatment of comorbidities depends on individual patient needs. As recommended in the Australian Asthma Handbook, some comorbidities such as obesity, allergic rhinitis and obstructive sleep apnoea, should be treated not only to improve patient health outcomes, but to also reduce their impact on asthma control and risk of flare-ups [9].

Medications prescribed for some comorbidities may interact with each other, which can cause problems for people with asthma. One example is beta-blockers, a treatment sometimes used for cardiovascular disease, glaucoma or anxiety. In people with asthma, beta-blockers given by tablet or eye-drops can cause severe asthma flare-ups, requiring more intense treatment and management. Another example is non-steroidal anti-inflammatory medications (NSAIDs) including aspirin, which may be used to treat cardiovascular disease or arthritis. These medications can cause severe flare-ups in around 7% of people with asthma [10].

For patients who have both asthma and COPD, treatment usually includes inhaled corticosteroids (anti-inflammatory medications) and long-acting bronchodilators, together with treatment of modifiable risk factors (such as smoking cessation and increasing physical activity), pulmonary rehabilitation, and vaccinations [9].

Due to the potential for interactions between different chronic conditions and the medications used to treat them, it is important that people with asthma tell their doctor(s) about any other conditions that they have, and any other treatment they are taking, so that their health can be carefully monitored.

References

  1. Australian Bureau of Statistics (ABS) 2015. National Health Survey: First Results, 2014–15. ABS Cat. no. 4364.0.55.001. Canberra: ABS.
  2. Caughey GE, Vitry AI, Gilbert AL & Roughhead EE 2008. Prevalence of comorbidity of chronic diseases in Australia. BMC Public Health 8.
  3. Cazzola M, Calzetta L, Bettoncelli G, Cricelli C, Romeo F, Matera MG et al. 2012. Cardiovascular disease in asthma and COPD: A population-based retrospective cross-sectional study. Respiratory Medicine 106.
  4. Boulet L-P, 2009. Influence of comorbid conditions on asthma. European Respiratory Journal. 33(4): 897-906.
  5. Van der Molen T. 2010. Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences. Primary Care Respiratory Journal, 19(4): 326–334.
  6. de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, et al. 2013. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): Prevalence and risk factors in young, middle-aged and elderly people from the general population. PloS One 8(5): e62985.
  7. Gibson PG & McDonald VM. 2015. Asthma—COPD overlap 2015: now we are six. Thorax; 70: 683-91.
  8. GINA 2015. Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (PDF). Viewed 27 May 2016.
  9. National Asthma Council Australia 2015. Australian asthma handbook, version 1.1. Melbourne: NACA. Viewed 22 February 2016.
  10. Rajan JP, Wineinger NE, Stevenson DD, White AA. 2015. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. Journal of Allergy and Clinical Immunology. 135: 676-81.e1.