Page 48 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 48
ties such are gastroesophageal reflux, obesity, Frequent comorbidities in asthma
and rhinitis7–9. and O SA
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma
Asthma and OSA-a lternative overlap Rhinitis: the prevalence of both allergic and
syndrome non-allergic rhinitis in asthma sufferers is es-
timated at 80 to 90%, and rhinitis is a risk fac-
OSA is the most common breathing disor- tor for the development of asthma17,18. Rhi-
der during sleep, typically occurring in obese nitis causes chronic inflammation and nasal
people5. Like asthma, OSA has its own phe- obstruction, which results in an increase in
notypes depending on the craniofacial mor- negative oropharyngeal pressure during in-
phology. Common risk factors for OSA in- spiration and predisposes to airway collapse,
clude male gender, age, obesity, increased increased apnea-hypopnea index (AHI) and
neck circumference (greater than 17 inches in OSA symptoms19. Chronic inflammation in
men and 16 in women), craniofacial abnor- the upper and lower respiratory tract can po-
malities (micrognathia, retrognathia), and the tentiate the development of OSA20.
presence of cardiovascular comorbidities4.
Certain studies point out that the presence of Gastroesophageal reflux disease (GERD):
OSA in patients with asthma can be a sepa- a common disorder found in about 58 to 65%
rate phenotype of asthma10,11. The frequency of patients with OSA and as many as 80% of
of OSA in severe asthma and difficult-to-treat patients with asthma7,21. Persistent symptoms
asthma ranges from 50 to 95%4. Such a large of GERD lead to inflammation of the upper
difference in frequency can be explained by respiratory tract, which can cause sleep frag-
the different methodology of the studies. In mentation, snoring during sleep. Frequent mi-
earlier studies, the methodology was based on croaspirations and direct injuries to the air-
self-reporting of snoring during sleep and pe- ways cause worsening of asthma by increasing
riods of apnea12,13. Recent studies have includ- the tendency to bronchial obstruction4.
ed polysomnography in their methodology.
After a four-year follow-up period, patients Obesity: Obesity is a risk factor for the
with asthma had a 40% higher risk of sleep development of OSA, but it is also an inde-
apnea compared to patients without asth- pendent risk factor for asthma4. As a complex
ma14. In one retrospective study, asthma pa- entity, it affects breathing through various
tients with frequent exacerbations, high doses mechanisms and physiological processes. Ac-
of inhaled corticosteroids and frequent use of cumulation of fatty tissue in the upper parts
systemic corticosteroids had a more frequent of the respiratory tract leads to an increase in
diagnosis of OSA (15). Studies using pol- resistance and collapsibility, while in the re-
ysomnography reported a higher incidence of gion of the chest and abdomen it leads to re-
sleep apnea (88 to 95%) compared to studies strictive disorders where functional residual
using a respiratory polygraphy (49% in severe capacity is reduced and ventilation is weak-
asthmatics)16. The significant difference in ened22. O SA is more common in obese men,
frequency can be explained by the following: while asthma is more common in obese wom-
the respiratory polygraphy can underestimate en, which suggests a potential influence of
the severity of OSA in patients with asthma; hormones23.
asthma can have an impact on the phenotyp-
ic expression of OSA by reducing the Aurosal Pathophysiological correlation between
index14. All this shows that more prospective OSA and severe asthma – bidirectional
research is necessary to evaluate the develop- interaction
ment of these two disorders.
OSA is an independent factor for the exac-
erbation of asthma and each condition in it-
self can have an effect on the worsening of
and rhinitis7–9. and O SA
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma
Asthma and OSA-a lternative overlap Rhinitis: the prevalence of both allergic and
syndrome non-allergic rhinitis in asthma sufferers is es-
timated at 80 to 90%, and rhinitis is a risk fac-
OSA is the most common breathing disor- tor for the development of asthma17,18. Rhi-
der during sleep, typically occurring in obese nitis causes chronic inflammation and nasal
people5. Like asthma, OSA has its own phe- obstruction, which results in an increase in
notypes depending on the craniofacial mor- negative oropharyngeal pressure during in-
phology. Common risk factors for OSA in- spiration and predisposes to airway collapse,
clude male gender, age, obesity, increased increased apnea-hypopnea index (AHI) and
neck circumference (greater than 17 inches in OSA symptoms19. Chronic inflammation in
men and 16 in women), craniofacial abnor- the upper and lower respiratory tract can po-
malities (micrognathia, retrognathia), and the tentiate the development of OSA20.
presence of cardiovascular comorbidities4.
Certain studies point out that the presence of Gastroesophageal reflux disease (GERD):
OSA in patients with asthma can be a sepa- a common disorder found in about 58 to 65%
rate phenotype of asthma10,11. The frequency of patients with OSA and as many as 80% of
of OSA in severe asthma and difficult-to-treat patients with asthma7,21. Persistent symptoms
asthma ranges from 50 to 95%4. Such a large of GERD lead to inflammation of the upper
difference in frequency can be explained by respiratory tract, which can cause sleep frag-
the different methodology of the studies. In mentation, snoring during sleep. Frequent mi-
earlier studies, the methodology was based on croaspirations and direct injuries to the air-
self-reporting of snoring during sleep and pe- ways cause worsening of asthma by increasing
riods of apnea12,13. Recent studies have includ- the tendency to bronchial obstruction4.
ed polysomnography in their methodology.
After a four-year follow-up period, patients Obesity: Obesity is a risk factor for the
with asthma had a 40% higher risk of sleep development of OSA, but it is also an inde-
apnea compared to patients without asth- pendent risk factor for asthma4. As a complex
ma14. In one retrospective study, asthma pa- entity, it affects breathing through various
tients with frequent exacerbations, high doses mechanisms and physiological processes. Ac-
of inhaled corticosteroids and frequent use of cumulation of fatty tissue in the upper parts
systemic corticosteroids had a more frequent of the respiratory tract leads to an increase in
diagnosis of OSA (15). Studies using pol- resistance and collapsibility, while in the re-
ysomnography reported a higher incidence of gion of the chest and abdomen it leads to re-
sleep apnea (88 to 95%) compared to studies strictive disorders where functional residual
using a respiratory polygraphy (49% in severe capacity is reduced and ventilation is weak-
asthmatics)16. The significant difference in ened22. O SA is more common in obese men,
frequency can be explained by the following: while asthma is more common in obese wom-
the respiratory polygraphy can underestimate en, which suggests a potential influence of
the severity of OSA in patients with asthma; hormones23.
asthma can have an impact on the phenotyp-
ic expression of OSA by reducing the Aurosal Pathophysiological correlation between
index14. All this shows that more prospective OSA and severe asthma – bidirectional
research is necessary to evaluate the develop- interaction
ment of these two disorders.
OSA is an independent factor for the exac-
erbation of asthma and each condition in it-
self can have an effect on the worsening of
