The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleComorbidities in Difficult-to-Control Asthma
Section snippets
Patients
Adults (≥18 years) with asthma and a prescription for high-intensity asthma treatment were selected from a Dutch pharmacy database. High-intensity treatment was defined as ≥1,000 μg/d fluticasone equivalent plus a long-acting β2-agonist (LABA), or 500-1,000 μg/d fluticasone equivalent plus chronic oral corticosteroids (OCS) (≥6 months, ≥5 mg/d prednisone equivalent) plus LABA. Questionnaires were sent by regular mail to all patients (n = 5,002), of which 2,312 (46.2%) were returned and
Results
Of the 2,312 patients who returned the questionnaires, 1,571 (67.9%) had asthma and were on high-intensity treatment. Of these, 914 (58.2%) had difficult-to-control asthma and 657 (41.8%) not-difficult-to-control asthma (Figure 1). Patients with difficult-to-control asthma were older (65.0 ± 13.8 y vs 61.5 ± 15.5 y; P < .01) and had a more extensive smoking history (22.5 (9.6-39.0) PY vs16.5 (6.4-31.0) PY; P < .01) as compared with patients with not-difficult-to-control asthma (Table I).
Discussion
This study shows that the majority (92%) of patients with difficult-to-control asthma have one or more comorbidities. Furthermore, patients with difficult-to-control asthma have more often multiple comorbidities than patients with not-difficult-to-control asthma. Cardiovascular disease, gastroesophageal reflux, anxiety/depression, and obesity are significantly more prevalent in patients with difficult-to-control asthma. Each of these comorbidities is associated with specific patient
Acknowledgements
P.-P.W.H., M.A., R.R.W., and E.H.B. contributed to the conception and design; P.-P.W.H., M.A., M.L.B., and E.H.B. contributed to the analysis and interpretation; and P.-P.W.H., M.L.B., and E.H.B. contributed to the drafting of the manuscript for important intellectual content.
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This study was financially supported by an unrestricted grant from Novartis Pharma BV.
Conflicts of interest: P.-P. Hekking, M. Amelink, R. R. Wener, and M. L. Bouvy have received research support from Novartis. E. H. Bel has received research support from Novartis, Sanofi, AstraZeneca, GlaxoSmithKline, Vectura, Teva, Boehringer, and Roche.