The role and significance of comorbid pathology in the management of patients with bronchial asthma

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Abstract

In the last decade, the Global Initiative for Asthma (GINA) has defined bronchial asthma (BA) control and personalized management of modifiable risk factors in patients, including comorbidities, as the main therapeutic targets. The presence of comorbidity is recognized as a common problem in patients with asthma, and the identification of comorbidities is recommended at each stage of BA treatment.

Comorbidities are more common in severe asthma, with more than 50% of patients having 3 or more comorbidities. Timely diagnosis of comorbidity is necessary for proper interdisciplinary management of patients with asthma, especially in severe cases. Difficult-to-treat and severe asthma are complex clinical conditions, and in case of insufficient their control physicians are tempted to escalate asthma treatment, including increasing corticosteroid therapy and initiating biological agents. However, BA control characteristics may be distorted by untreated comorbidities, which reduces the effectiveness of BA pharmacotherapy. In this regard, systematic assessment of comorbid pathology, which significantly contributes to the uncontrolled BA course and exacerbations, worsens the general health of patients, should be an important part of the therapeutic strategy for BA, especially in severe course. High frequency of comorbidities related to the cumulative effect of systemic glucocorticosteroids (SGCS), which should be interpreted as iatrogenic, are associated with unfavorable BA outcomes and the greatest deterioration in the quality of life of patients, which emphasizes the importance of minimizing repeated courses of SGCS and timely initiation of biological therapy in order to improve not only the clinical outcomes of BA, but also the prevention of steroid-associated comorbidity. Taking into account the multifaceted relationship between BA and comorbidities, it is necessary to consider and compare the potential benefits and risks of treating comorbid diseases when making therapeutic decisions.

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About the authors

Irina N. Trofimenko

Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: tin11@mail.ru
ORCID iD: 0000-0003-2742-3794
SPIN-code: 9345-4572

Dr. Sci. (Med), Associate Professor, Head of the Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

Boris A. Chernyak

Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: ba.chernyak@gmail.com
ORCID iD: 0000-0002-5902-6198
SPIN-code: 5928-2586

Dr. Sci. (Med), Professor, Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

Darima A. Tsyndymeeva

Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: darimouse@yandex.ru
ORCID iD: 0009-0000-5919-5496
SPIN-code: 9011-1846

Postgraduate Student, Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

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