Combined Effect of Multimorbidity and Increased Body Mass Index on Control of Bronchial Asthma and Quality of Patients’ Life

INTRODUCTION: Bronchial asthma (BA) is a serious medical and social problem due to its increasing prevalence, significant burden on healthcare and the persisting high level of disability and mortality.

AIM: To study a combined effect of multimorbidity and increased body mass index (BMI) on BA control and quality of life (QL) of patients to determine the possibilities of optimization of personalized program of patient management.

MATERIALS AND METHODS: Two hundred thirty seven patients with BA were divided to 3 groups: 1 — with normal body weight (n = 59; 24.9%); 2 — with overweight (n = 69; 29.1%); 3 — with obesity (n = 109; 46.0%). The level of multimorbidity was analyzed by Charlson comorbidity Index (CCI) and the cumulative illness rating scale (CIRS); BA control — by ASTTM and ACQ-5; QL — by AQLQ. The average number of groups of comorbid diseases (according to CIRS) was 7.44 ± 0.95, while 13.5% of patients had 1–2 groups of comorbid diseases, 33.8% — 3–4 groups, 46.8% ≥ 5 groups. In the group of obesity, 82.6% of patients had ≥ 5 groups of diseases. The average score of CIRS index was 7.44 ± 0.95 points, the maximum score was 19, the minimum was 2. In the first group, the average value of CIRS index was 4.68 ± 0.31 points, in the second — 5.62 ± 0.43 points, in the third — 10.1 ± 1.9 points (p_{1, 2} = 0.001, p_{1, 3} < 0.0001, p_{2, 3} < 0.0001).

RESULTS: Ten patients (4%) had fully controlled BA by АСТ™ and 33 (14%) — by ACQ-5. In the group with obesity, controlled BA was not detected (÷2 = 34.128; p = 0.0002), (F = 41.362; p < 0.001). With increase in the number of comorbid diseases, the control of BA reliably decreased; thus, in groups 2 and 3 with the existence of ≥ 5 groups of comorbid diseases, asthma had uncontrolled course with the lowest parameters in patients with obesity (р < 0.05). Analysis of BA by AQLQ showed negative influence of the disease on the severity of symptoms, motor activity, general QL of patients with obesity. The data obtained are confirmed by the correlation analysis.

CONCLUSION: Multimorbidity negatively influences control of BA: increase in CCI and CIRS parameters considerably impairs control of BA. Increase in BMI is a significant additional risk factor of impairment of BA control. Multimorbidity in combination with obesity significantly impairs QL of patients with BA according to AQLQ. The absence of control of BA according to АСТ™ and ACQ-5 influences the quality of life of patients with BA. The evaluation of multimorbidity and BMI must be included in the personalized program for management of patients with BA to take into account multivariate assessment of treatable signs of the disease.