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Study on the Prevalence of Non-respiratory Comorbidities in Asthma Patients: A Nationwide Cohort Study

천식환자의 비호흡기 동반질환 유병률 분석연구: 전국민 코호트 연구

  • Su-Jin Kang (College of Pharmacy, Dongduk Women's University) ;
  • Kiyon Rhew (College of Pharmacy, Dongduk Women's University)
  • 강수진 (동덕여자대학교 약학대학) ;
  • 유기연 (동덕여자대학교 약학대학)
  • Received : 2024.08.23
  • Accepted : 2024.09.13
  • Published : 2024.09.30

Abstract

Background: Asthma is a chronic inflammatory airway disease associated with systemic inflammation and increased prevalence of various comorbid conditions. This study investigates the prevalence of non-respiratory comorbidities among adult asthma patients in South Korea, aiming to elucidate potential correlations and impacts of asthma on overall health, thereby affecting patients' quality of life and healthcare systems. Methods: This retrospective cohort study utilized the National Health Insurance Service data (HIRA-NPS-2020) and included adults diagnosed with asthma. Non-respiratory diseases were identified using the Korean Standard Disease Classification (KCD-8) codes, with exclusions applied for other respiratory conditions. The prevalence of comorbidities was analyzed and compared between asthma and non-asthma patients, adjusting for confounders such as age, gender, and insurance status through inverse probability treatment weighting (IPTW). Results: The analysis revealed that asthma patients exhibit significantly higher rates of cardiovascular diseases, metabolic disorders, gastrointestinal conditions, and mental health issues compared to the control group. Notably, conditions such as heart failure, gastroesophageal reflux disease, and anxiety were more prevalent, with odds ratios (OR) ranging from 1.18 to 3.90. These results demonstrate a substantial burden of comorbidities associated with asthma, indicating a broad impact on health beyond the respiratory system. Conclusion: The findings highlight the systemic nature of asthma and the interconnectedness of inflammatory processes across different organ systems. This comprehensive analysis confirms previous research linking asthma with an increased risk of various non-respiratory diseases, providing insights into the multifaceted impact of asthma on patient health.

Keywords

Acknowledgement

이 논문은 2022년도 동덕여자대학교 연구비 지원에 의하여 수행된 것으로 이에 감사드립니다.

References

  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention: Online Appendix 2020. Available from http://www.ginasthma.org/. Accessed May 25, 2023. 
  2. Lambrecht BN, Hammad H, Fahy JV. The Cytokines of Asthma. Immunity 2019;50(4):975-91.  https://doi.org/10.1016/j.immuni.2019.03.018
  3. Peebles RS Jr. Prostaglandins in asthma and allergic diseases. Pharmacol Ther 2019;193:1-19.  https://doi.org/10.1016/j.pharmthera.2018.08.001
  4. Salles-Dias LP, Brandao-Rangel MAR, Cristina-Rosa A, et al. Functional analysis of airway remodeling is related with fibrotic mediators in asthmatic children. J Asthma 2024;19:1-10. 
  5. Hammad H, Lambrecht BN. The basic immunology of asthma. Cell 2021;184(9):2521-22.  https://doi.org/10.1016/j.cell.2021.04.019
  6. Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008-2013. Ann Am Thorac Soc 2018;15(3):348-56.  https://doi.org/10.1513/AnnalsATS.201703-259OC
  7. Rogliani P, Sforza M, Calzetta L. The impact of comorbidities on severe asthma. Curr Opin Pulm Med 2020;26(1):47-55.  https://doi.org/10.1097/MCP.0000000000000640
  8. McLoughlin RF, McDonald VM. The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma. Front Allergy 2021;2:735030. 
  9. Varkonyi-Sepp J, Freeman A, Ainsworth B, Kadalayil LP, Haitchi HM, Kurukulaaratchy RJ. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J Pers Med 2022;12(9):1435. 
  10. Ilmarinen P, Tuomisto LE, Niemela O, et al. Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma. Eur Respir J 2016;48(4):1052-62.  https://doi.org/10.1183/13993003.02198-2015
  11. Steppuhn H, Langen U, Keil T, Scheidt-Nave C. Chronic disease co-morbidity of asthma and unscheduled asthma care among adults: results of the national telephone health interview survey German Health Update (GEDA) 2009 and 2010. Prim Care Respir J 2014;23(1):22-9.  https://doi.org/10.4104/pcrj.2013.00107
  12. Lee HM, Truong ST, Wong ND. Association of adult-onset asthma with specific cardiovascular conditions. Respir Med 2012;106(7):948-53.  https://doi.org/10.1016/j.rmed.2012.02.017
  13. de Boer GM, Tramper-Stranders GA, Houweling L, et al. Adult but not childhood onset asthma is associated with the metabolic syndrome, independent from body mass index. Respir Med 2021;188:106603. 
  14. Dogra S, Ardern CI, Baker J. The relationship between age of asthma onset and cardiovascular disease in Canadians. J Asthma 2007;44(10):849-54.  https://doi.org/10.1080/02770900701752391
  15. de Nijs SB, Venekamp LN, Bel EH. Adult-onset asthma: is it really different? [published correction appears in Eur Respir Rev 2013 Jun 1;22(128):193]. Eur Respir Rev 2013;22(127):44-52.  https://doi.org/10.1183/09059180.00007112
  16. Cardet JC, Bulkhi AA, Lockey RF. Nonrespiratory Comorbidities in Asthma. J Allergy Clin Immunol Pract 2021;9(11):3887-97.  https://doi.org/10.1016/j.jaip.2021.08.027
  17. Su X, Ren Y, Li M, Zhao X, Kong L, Kang J. Prevalence of Comorbidities in Asthma and Nonasthma Patients: A Meta-analysis. Medicine (Baltimore) 2016;95(22):e3459. 
  18. Robinson D, Humbert M, Buhl R, et al. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy 2017;47(2):161-75.  https://doi.org/10.1111/cea.12880
  19. Kuruvilla ME, Lee FE, Lee GB. Understanding Asthma Phenotypes, Endotypes, and Mechanisms of Disease. Clin Rev Allergy Immunol 2019;56(2):219-33.  https://doi.org/10.1007/s12016-018-8712-1
  20. Papi A, Brightling C, Pedersen SE, Reddel HK. Asthma. Lancet 2018;391(10122):783-800.  https://doi.org/10.1016/S0140-6736(17)33311-1
  21. Nordenstedt H, Nilsson M, Johansson S, et al. The relation between gastroesophageal reflux and respiratory symptoms in a population-based study: the Nord-Trondelag health survey. Chest 2006;129(4):1051-6.  https://doi.org/10.1378/chest.129.4.1051
  22. Blakey JD, Price DB, Pizzichini E, et al. Identifying Risk of Future Asthma Attacks Using UK Medical Record Data: A Respiratory Effectiveness Group Initiative. J Allergy Clin Immunol Pract 2017;5(4):1015-24.  https://doi.org/10.1016/j.jaip.2016.11.007
  23. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol 2018;141(4):1169-79.  https://doi.org/10.1016/j.jaci.2018.02.004
  24. Koebnick C, Fischer H, Daley MF, et al. Interacting effects of obesity, race, ethnicity and sex on the incidence and control of adult-onset asthma. Allergy Asthma Clin Immunol 2016;12:50.
  25. Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013;17(8):356. 
  26. Martinez-Moragon E, Plaza V, Torres I,. Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study. Curr Med Res Opin 2017;33(12):2181-6.  https://doi.org/10.1080/03007995.2017.1354828
  27. Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 2002;17(10):2715-24.  https://doi.org/10.1093/humrep/17.10.2715
  28. Moore WC, Meyers DA, Wenzel SE, et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med 2010;181(4):315-3. 
  29. Barbato A, Turato G, Baraldo S, et al. Epithelial damage and angiogenesis in the airways of children with asthma. Am J Respir Crit Care Med 2006;174(9):975-81.  https://doi.org/10.1164/rccm.200602-189OC
  30. Phelan PD, Robertson CF, Olinsky A. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol 2002;109(2):189-94.  https://doi.org/10.1067/mai.2002.120951
  31. Liu MC, Hubbard WC, Proud D, et al. Immediate and late inflammatory responses to ragweed antigen challenge of the peripheral airways in allergic asthmatics. Cellular, mediator, and permeability changes. Am Rev Respir Dis 1991;144(1):51-8.  https://doi.org/10.1164/ajrccm/144.1.51
  32. Cazzola M, Rogliani P, Ora J, Calzetta L, Matera MG. Asthma and comorbidities: recent advances. Pol Arch Intern Med 2022;132(4):16250. 
  33. Kwon JH, Wi CI, Seol HY, et al. Risk, Mechanisms and Implications of Asthma-Associated Infectious and Inflammatory Multimorbidities (AIMs) among Individuals With Asthma: a Systematic Review and a Case Study. Allergy Asthma Immunol Res 2021;13(5):697-718.  https://doi.org/10.4168/aair.2021.13.5.697
  34. Chang JE, Lee HM, Kim J, Rhew K. Prevalence of Anemia in Pediatric Patients According to Asthma Control: Propensity Score Analysis. J Asthma Allergy 2021;14:743-51.  https://doi.org/10.2147/JAA.S318641
  35. Rhew K, Choi J, Kim K, Choi KH, Lee SH, Park HW. Increased Risk of Anemia in Patients with Asthma. Clin Epidemiol 2023;15:31-8.  https://doi.org/10.2147/CLEP.S394717
  36. Liu L, Liu Y, Zhang X, et al. Dyslipidemia Is Associated With Worse Asthma Clinical Outcomes: A Prospective Cohort Study. J Allergy Clin Immunol Pract 2023;11(3):863-72.e8.  https://doi.org/10.1016/j.jaip.2022.11.037
  37. Hyland ME, Lanario JW, Wei Y, Jones RC, Masoli M. Evidence for similarity in symptoms and mechanism: The extra-pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia. Immun Inflamm Dis 2019;7(4):239-49. https://doi.org/10.1002/iid3.263