Co-morbidities and Conditions

Co-morbidity/condition

Literature that supports the association with the complexity of asthma management

Acetylsalicylic acid sensitivity

• Data from a large nation-wide moderate quality cross-sectional study found that acetylsalicylic acid-exacerbated respiratory disease contributed significantly to hospitalization and emergency department admissions in a population with asthma (Steppuhn, Langen, Scheidt-Nave, & Keil, 2013).

Allergic rhinitis

• Data from a moderate quality cross-sectional study found that 80% of all asthma patients had rhinitis symptoms. A negative correlation was found between allergic rhinitis and asthma-related quality of life, but not asthma control (Hayat et al., 2014).
• Additional cross-sectional studies that support allergic rhinitis as a common co-morbid condition in persons with asthma: Hwang et al. (2012) and Steppuhn et al. (2013).
• Additional references that support allergic rhinitis as a factor in the complexity of management: GINA (2015) and NIH (2007).

Anxiety and

Depression

• Data from a strong quality cross-sectional study demonstrated that having an anxiety disorder and having a mood disorder are independently associated with poorer asthma control (Ouellet et al., 2012). 
• Additional references that identify anxiety as a potential factor in the complexity of asthma management: Favreau et al. (2014) and GINA (2015).
• A number of observational studies have documented a relationship between co-morbid depression and poorer asthma control or greater asthma severity (Krauskopf et al., 2013; Mazurek et al., 2012; Ross et al., 2013; Trzcinska, Przybylski, Kozlowski, & Derdowski, 2012; Wiltens, Theunissen, Glasser, & Zeitz, 2012).
• Additional references that support depression as a factor in the complexity of management: GINA (2015) and NIH (2007).

Atopic dermatitis

• Data from a moderate quality cross-sectional study indicated atopic dermatitis as an independent factor associated with poorly controlled asthma (Vervloet et al., 2014).

Cardiovascular disease

• Persons with cardiovascular disease and asthma may have adverse reactions to inhaled SABA therapy (NIH, 2007).
• NIH (2007) indicates co-morbid cardiovascular disease as one risk factor for death from asthma.

Conditions associated with beta-blocker use

• Use of beta-blockers may make asthma symptoms worse (GINA, 2015; NIH, 2007).
• Examples of conditions associated with beta-blocker use include (but are not limited to) hypertension, cardiovascular disease, eye disease, anxiety, and migraines.

Gastroespohageal reflux (GERD)

• A moderate quality cross-sectional study found that GERD negatively affected quality of life and asthma control in persons with asthma (Hayat et al., 2014).
• Additional references that support the association between GERD and complexity of asthma management: GINA (2015), Liang and Feng (2013) and NIH (2007).

Obstructive sleep apnea (OSA)

• Data from a moderate quality cross-sectional study on a large sample of asthma patients showed that symptoms indicative of high OSA risk or diagnosed and untreated OSA (e.g., pauses in breathing during sleep, sudden gasping arousals from sleep, worsening of snoring while supine or following alcohol consumption) are associated with persistent asthma symptoms during the daytime. Further, continuous positive airway pressure (CPAP), used in the treatment of OSA, reduced the likelihood of persistent daytime asthma symptoms (Teodorescu et al., 2012).
• Additional references that support the association of OSA and the complexity of asthma management: GINA (2015), Kim et al. (2013), Liang and Feng (2013) and NIH (2007).

Overweight and Obesity

• Data from a moderate quality cross-sectional study found obesity to be significantly associated with greater asthma severity and poorer asthma control and quality of life (Maalej et al., 2012).
• Additional references that support the relationship between obesity and its affect on asthma management: Boudreau et al. (2014), Ciprandi et al. (2014), GINA (2015), NIH (2007),  BTS/SIGN (2014) and Vervloet et al. (2014).
• References that support the relationship between overweight and poorer asthma outcomes: Boudreau et al. (2014), Ciprandi et al. (2014) and Maalej et al. (2012).

Pregnancy

• Asthma may improve, worsen or remain unchanged during pregnancy (BTS/SIGN, 2014).

Vocal cord dysfunction (VCD)

• Abnormal movement of the vocal cords is often mistaken for asthma, and therefore should be considered in asthma that is difficult to treat (NIH, 2007). VCD and asthma may co-exist, which complicates management (NIH, 2007).