Page 48 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 48
severe asthma forum 1: severe asthma - basic and clinical views Figure 2. Comorbidities in the Wessex AsThma CoHort of difficult asthma (WATCH) study.
Abbreviations: GORD – Gastro-oesophageal reflux disease.
to u nderstand the numerous challenges faced An important new taxonomic approach
by patients with problematic asthma. to airways disease based on identifying and
managing component factors rather than ge-
Real-world studies clearly demonstrate neric disease labels such as asthma was re-
the significant level of ongoing comorbidity cently proposed by Augusti et al to provide
seen in patients with difficult asthma. For ex- structure to this understanding of multimor-
ample in the Wessex AsThma CoHort of dif- bidity in airways diseases like difficult asth-
ficult asthma (WATCH) study based in the ma.23 Such potentially modifiable factors,
tertiary referral Difficult Asthma Clinic at known as “treatable traits” are broadly cat-
Southampton, United Kingdom (UK), high egorised as pulmonary, extrapulmonary and
prevalence of physical comorbidities like rhi- behavioural in nature and occur concurrent-
nitis and gastro-oesophageal reflux disease ly in combinations that may be specific to an
(GORD) were noted. But so too were psycho- individual patient. Pulmonary traits might in-
physiologic comorbidities like anxiety, depres- clude fixed airflow limitation, small airways
sion, dysfunctional breathing patterns and in- disease, pattern of airway inflammation (eo-
ducible laryngeal obstruction/vocal cord sinophilic, neutrophilic, mixed inflammatory,
dysfunction (Figure 2). Recent findings from paucicellular), allergic fungal airways disease,
the WATCH study have also demonstrat- aspirin exacerbated respiratory disease, bron-
ed differing associations of these various co- chiectasis, airway infections and dual COPD.
morbidities with difficult asthma phenotypes Extrapulmonary traits could include rhinitis,
based on age of asthma onset/sex which merit chronic rhinosinusitis (with or without pol-
wider understanding.22 In particular, psycho- yps), gastro-oesophageal reflux disease, obe-
physiologic comorbidities and obesity tended sity, obstructive sleep apnoea, physical decon-
to be commoner in females with difficult asth- ditioning, dysfunctional breathing, inducible
ma in that study highlighting other treatment laryngeal obstruction (ILO)/vocal cord dys-
options beyond asthma pharmacotherapy for function (VCD), anxiety, and depression.
particular subgroups.22
Abbreviations: GORD – Gastro-oesophageal reflux disease.
to u nderstand the numerous challenges faced An important new taxonomic approach
by patients with problematic asthma. to airways disease based on identifying and
managing component factors rather than ge-
Real-world studies clearly demonstrate neric disease labels such as asthma was re-
the significant level of ongoing comorbidity cently proposed by Augusti et al to provide
seen in patients with difficult asthma. For ex- structure to this understanding of multimor-
ample in the Wessex AsThma CoHort of dif- bidity in airways diseases like difficult asth-
ficult asthma (WATCH) study based in the ma.23 Such potentially modifiable factors,
tertiary referral Difficult Asthma Clinic at known as “treatable traits” are broadly cat-
Southampton, United Kingdom (UK), high egorised as pulmonary, extrapulmonary and
prevalence of physical comorbidities like rhi- behavioural in nature and occur concurrent-
nitis and gastro-oesophageal reflux disease ly in combinations that may be specific to an
(GORD) were noted. But so too were psycho- individual patient. Pulmonary traits might in-
physiologic comorbidities like anxiety, depres- clude fixed airflow limitation, small airways
sion, dysfunctional breathing patterns and in- disease, pattern of airway inflammation (eo-
ducible laryngeal obstruction/vocal cord sinophilic, neutrophilic, mixed inflammatory,
dysfunction (Figure 2). Recent findings from paucicellular), allergic fungal airways disease,
the WATCH study have also demonstrat- aspirin exacerbated respiratory disease, bron-
ed differing associations of these various co- chiectasis, airway infections and dual COPD.
morbidities with difficult asthma phenotypes Extrapulmonary traits could include rhinitis,
based on age of asthma onset/sex which merit chronic rhinosinusitis (with or without pol-
wider understanding.22 In particular, psycho- yps), gastro-oesophageal reflux disease, obe-
physiologic comorbidities and obesity tended sity, obstructive sleep apnoea, physical decon-
to be commoner in females with difficult asth- ditioning, dysfunctional breathing, inducible
ma in that study highlighting other treatment laryngeal obstruction (ILO)/vocal cord dys-
options beyond asthma pharmacotherapy for function (VCD), anxiety, and depression.
particular subgroups.22
