Managing co-existing conditions

Many people with asthma have other, associated health conditions. Symptoms of these conditions occur frequently and add to the burden of respiratory symptoms. They can affect the nature and severity of asthma, leading to a distinct phenotype (observable physical properties of a person). They can be grouped as “airway-related” such as hay fever (allergic rhinitis), or “airway-unrelated” such as obesity [Bardin et al 2018].

People we interviewed spoke of both kinds of co-existing conditions. Regarding airway-related conditions that are known to have an impact on severe asthma, other conditions such as hay fever, chronic sinusitis, chronic obstructive pulmonary disease [COPD], bronchiectasis, and aspergillosis (a fungal condition) were mentioned by people in the study. The most common airway condition talked about was hay fever, which matches well with research showing the occurrence of hay fever in severe asthma may be as high as 68% [Ohta et al 2011].

Marea tries to keep a lid on her hay fever.
Lauren has a group of allergic conditions.
Hassan remembers sinus problems long before asthma started.
The treatment for John B’s fungal infection in his lungs makes his cushingoid symptoms worse.
Marion has bronchiectasis, and has also had aspergillus in the past.

From a medical perspective, there is considerable overlap in the airway inflammation seen in severe asthma and COPD. [Cowan et al 2010]. A couple of people we talked to had been given diagnoses of both severe asthma and COPD and this was confusing for them.

Ian just thought the names given by healthcare providers related to the same thing.

Regarding conditions that are not related to the airways but known to have an impact on severe asthma, people we interviewed talked about reflux, obesity, and sleep apnoea. Gastro-oesophageal reflux disease [GORD] is common in patients with severe asthma.

Antacids helped with Leanne’s congestion.
Treating Jemma’s reflux has improved her asthma control.
Tony mistook symptoms of reflux for asthma.

Obesity also occurs frequently in people with asthma. Obesity-associated late-onset asthma appears to be a distinct phenotype of severe asthma and is more common in women. [Gibeon et al 2013]. Women we interviewed recognised that it was best for their breathing not to be carrying extra weight but found it hard to lose weight whilst taking steroids and other medication. Some were sent to an obesity clinic to help with losing weight.

Helen sees several benefits with losing weight.
Shannon is frustrated that the doctors see her weight gain as her fault.
Diana doesn’t want to add any more weight for the asthma to deal with.

Several people we interviewed reported that they had been tested for and diagnosed with sleep apnoea. Sometimes it was difficult for them to know if sleep problems were due to sleep apnoea or the severe asthma.

Ian puts down his disturbed sleep to lack of oxygen.

Most people in the study also reported conditions that developed as a result of the steroid and medications taken for their asthma. Commonly reported ones were diabetes, cataracts, and osteoporosis. See Managing Medications.

The steroids John G was taking daily shut down his adrenal system.

References:

  1. Bardin PG, Ranggaswamy J, Yo SW. Managing comorbid conditions in severe asthma. Medical Journal of Australia 2018; 209 (2 Suppl).
  2. Ohta K, Bousquet PJ, Aizawa H, et al. Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan. Allergy 2011; 66: 1287-1295.
  3. Cowan DC, Cowan JO, Palmay R, et al. Effects of steroid therapy on inflammatory cell subtypes in asthma. Thorax 2010; 65: 384-390.
  4. Gibeon D, Batuwita K, Osmond M, et al. Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI. Chest 2013; 143: 406-414