Exacerbations Among Patients With Asthma Are Largely Dependent on the Presence of Multimorbidity
Por:
Domínguez-Ortega J., Luna-Porta J.A., Olaguibel J.M., Barranco P., Arismendi E., Barroso B., Betancor D., Bobolea I., Caballero M.L., Cárdaba B., Cruz M.J., Curto E., González-Barcala F.J., Losantos-García I., Martínez-Rivera C., Mendez-Brea P., Mullol J., Munoz, X, Picado C., Plaza V., Del Pozo V., Rial M.J., Sastre J., Soto L., Valero A., Valverde-Monge M., Quirce S.
Publicada:
1 ene 2023
Ahead of Print:
3 may 2022
Resumen:
Introduction: Comorbidities can influence asthma control and promote asthma exacerbations (AEs). However, the impact of multimorbidity in AEs, assessed based on long-term follow-up of patients with asthma of different degrees of severity, has received little attention in real-life conditions.Objective: To describe the epidemiological and clinical characteristics and predictors of AEs in patients who had presented at least 1 AE in the previous year in the MEchanism of Genesis and Evolution of Asthma (MEGA) cohort. Methods: The work-up included a detailed clinical examination, pulmonary function testing, fractional exhaled nitric oxide (FeNO), blood counts, induced sputum, skin prick-tests, asthma questionnaires, and assessment of multimorbidity. The number of moderate-severe AEs in the preceding year was registered for each patient.Results: The study population comprised 486 patients with asthma (23.7% mild, 35% moderate, 41.3% severe). Disease remained uncontrolled in 41.9%, and 47.3% presented & GE;1 moderate-severe AE, with a mean (SD) annual exacerbation rate of 0.47 (0.91) vs 2.11 (2.82) in mild and severe asthma, respectively. Comorbidity was detected in 56.4% (66.6% among those with severe asthma). Bronchiectasis, chronic rhinosinusitis with nasal polyps, atopy, psychiatric illnesses, hyperlipidemia, and hypertension were significantly associated with AEs. No associations were found for FeNO, blood eosinophils, or total serum IgE. Sputum eosinophilia and a high-T2 inflammatory pattern were significantly associated with AEs. Multivariable regression analysis showed a significant association with asthma severity, uncontrolled disease, and low prebronchodilator FEV1/FVC.Conclusions: Our study revealed a high frequency of AE in the MEGA cohort. This was strongly associated with multimorbidity, asthma severity, poor asthma control, airflow obstruction, higher sputum eosinophils, and a very high-T2 inflammatory pattern.Key words: Asthma. Exacerbations. MEGA cohort. Asthma control. Multimorbidity.
Filiaciones:
Domínguez-Ortega J.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Luna-Porta J.A.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
IdiPAZ, La Paz Univ Hosp, Dept Allergy, Paseo de la Castellana 261, Madrid 28046, Spain
Olaguibel J.M.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Complejo Hosp Navarra, Dept Allergy, Severe Asthma Unit, Pamplona, Navarra, Spain
Barranco P.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Arismendi E.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Clin & Expt Resp Immunoallergy IDIBAPS, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Hosp Clin Barcelona, Pneumonol & Allergy Dept, Allergy Unit & Severe Asthma Unit, Barcelona, Spain
Barroso B.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Allergy, Madrid, Spain
Betancor D.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Allergy, Madrid, Spain
Bobolea I.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Clin & Expt Resp Immunoallergy IDIBAPS, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Hosp Clin Barcelona, Pneumonol & Allergy Dept, Allergy Unit & Severe Asthma Unit, Barcelona, Spain
Caballero M.L.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Cárdaba B.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Immunol, Madrid, Spain
Cruz M.J.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Univ Autonoma Barcelona, Dept Biol Celular Fisiol & Inmunol, Barcelona, Spain
Hosp Valle De Hebron, Pneumol Dept, Barcelona, Spain
Curto E.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Santa Creu i St Pau, Resp Med Dept, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
González-Barcala F.J.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Complejo Hosp Univ Santiago, Pneumol Dept, La Coruna, Spain
Inst Invest Sanitaria Santiago de Compostela FIDIS, La Coruna, Spain
Univ Santiago de Compostela, La Coruna, Spain
Losantos-García I.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
La Paz Univ Hosp, Biostat Dept, Madrid, Spain
Martínez-Rivera C.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Hosp Germans Trias i Pujol, Pneumol Dept, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Badalona, Barcelona, Spain
Mendez-Brea P.:
Complejo Hosp Univ Santiago, Dept Allergy, , Coruna, Santiago De Compostela, Spain
Mullol J.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Clin & Expt Resp Immunoallergy IDIBAPS, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Hosp Clin Barcelona, ENT Dept, Rhinol Unit & Smell Clin, Barcelona, Spain
Munoz, X:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Valle De Hebron, Pneumol Dept, Barcelona, Spain
Picado C.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Clin & Expt Resp Immunoallergy IDIBAPS, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Hosp Clin Barcelona, Pneumonol & Allergy Dept, Allergy Unit & Severe Asthma Unit, Barcelona, Spain
Plaza V.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Santa Creu i St Pau, Resp Med Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Del Pozo V.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Immunol, Madrid, Spain
Rial M.J.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Complexo Hosp Univ Coruna, Dept Allergy, La Coruna, Spain
Sastre J.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Allergy, Madrid, Spain
Soto L.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Santa Creu i St Pau, Resp Med Dept, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Valero A.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Univ Barcelona, Barcelona, Spain
Hosp Clin Barcelona, Pneumonol & Allergy Dept, Allergy Unit & Severe Asthma Unit, Barcelona, Spain
Valverde-Monge M.:
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Dept Allergy, Madrid, Spain
Quirce S.:
La Paz Univ Hosp, Dept Allergy, Madrid, Spain
Inst Hlth Res IdiPAZ, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
gold, All Open Access; Bronze
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