Asthma comorbidities… Do they make a difference?
Speaker: Prof. Zuzanna Diamant, Netherlands
Asthma is a complex disease worsened by comorbidities like CRSwNP, GERD, OSA, and obesity, which share inflammatory pathways and reduce treatment effectiveness. Obesity, in particular, exacerbates airway inflammation and poor asthma control. A treatable traits approach and multidisciplinary care can improve outcomes by targeting both pulmonary and non-pulmonary factors.
The Complexity of Asthma and Its Connected Comorbidities
Asthma is a heterogeneous disease influenced by multiple factors, including airway inflammation, environmental triggers, and genetic predisposition.1 However, its burden extends beyond the lungs, as comorbid conditions often coexist and significantly impact disease severity and treatment response. The “Connected Comorbidities Concept” emphasizes how asthma is part of a broader network of conditions, including chronic rhinosinusitis with nasal polyps (CRSwNP), gastroesophageal reflux disease (GERD), obstructive sleep apnoea (OSA), obesity, and psychological disorders.2,3 These conditions often share inflammatory pathways or physiological interactions that worsen asthma control, leading to increased exacerbations, impaired lung function, and poor treatment response.4
Obesity, for instance, has emerged as a major non-respiratory comorbidity of asthma, with a bidirectional relationship. The prevalence of obesity has tripled globally in recent decades, affecting an estimated three billion people.5 Its impact on asthma includes increased airway inflammation, worsened lung function, reduced medication effectiveness, and higher exacerbation rates.6 Additionally, obesity contributes to the development of GERD and OSA – both of which further impair asthma control through mechanisms such as micro-aspiration, vagal reflexes, and systemic inflammation.7
The Treatable Traits Approach: A Path Toward Personalized Asthma Care
Many asthma comorbidities can be classified as treatable traits (TTs) – specific characteristics that, when identified and addressed, can improve disease outcomes.8 These include:
| Pulmonary traits | Airway inflammation (eosinophilic, neutrophilic), bronchoconstriction, and fixed airway obstruction |
| Extra-pulmonary traits | Conditions such as obesity, CRSwNP, GERD, and psychological disorders, which directly or indirectly affect asthma control9 |
| Behavioural/environmental traits | Factors such as medication non-adherence, occupational exposures, and stress, which influence treatment success. |
A multidisciplinary approach – integrating pulmonologists, allergists, ENT specialists, and psychologists – is often necessary to effectively manage asthma and its comorbidities. Addressing these interconnected conditions using targeted therapies can break the cycle of exacerbations, reduce corticosteroid dependence, and enhance patients’ quality of life.10
Nicolai Krogh
Medical Advisor Primary care
References
- Maspero J, Adir Y, Al-Ahmad M, et al. Type 2 inflammation in asthma and other airway diseases. ERJ Open Res. 2022;8(3):00576-2021. Published 2022 Aug 1. doi:10.1183/23120541.00576-2021
- Boulet LP. Influence of comorbid conditions on asthma. Eur Respir J. 2009;33(4):897-906. doi:10.1183/09031936.00121308
- Asano K, Ueki S, Tamari M, Imoto Y, Fujieda S, Taniguchi M. Adult-onset eosinophilic airway diseases. Allergy. 2020;75(12):3087-3099. doi:10.1111/all.14620
- Rogliani P, et al. Strength of association between comorbidities and asthma: a meta-analysis. Eur Respir Rev. 2023;32(220202).
- World Obesity Federation. Global Obesity Report. 2023. Available from: https://www.worldobesity.org.
- Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(6):1169-1179.
- Tay TR, Hew M. Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation. Allergy. 2018;73(7):1369-1382. doi:10.1111/all.13370
- McDonald VM, et al. The treatable traits approach in asthma management. J Allergy Clin Immunol Pract. 2024.
- Papi A, Faner R, Pavord I, et al. From treatable traits to GETomics in airway disease: moving towards clinical practice. Eur Respir Rev. 2024;33(171):230143. Published 2024 Jan 17. doi:10.1183/16000617.0143-2023
- Gibson PG, McDonald VM. Integrating hot topics and implementation of treatable traits in asthma. Eur Respir J. 2024;64(6):2400861. Published 2024 Dec 5. doi:10.1183/13993003.00861-2024
ID 13775-24.03.2025