Comorbidity in severe asthma

Abstract

Iako predstavljaju mali postatak u bolesnika s astmom, oni s teškom astmom koriste značajne zdravstvene troškove i predstavljaju javnozdravstveni problem. Stoga je u ovoj skupini bolesnika postizanje bolje kontrole astme od ključne važnosti. Kontrola astme poboljšava se sustavnom procjenom bolesnika s mogućom teškom astmom i utvrđivanjem uzroka simptoma, uključujući komorbiditete. Komorbiditeti su česti u teškoj astmi, imaju značajan utjecaj na prognozu, a sve su važniji i u prepoznavanju fenotipova astme, koji pomažu u određivanju prikladnijih algoritama za procjenu, liječenje i praćenje ove bolesti. Najčešći komorbiditeti u teškoj astmi su alergijski rinitis, kronični rinosinusitis, nosni polipi, disfunkcionalno disanje, disfunkcija glasnica, pretilost, opstruktivna apneja u spavanju, bolest gastroezofagealnog refluksa, bronhiektazije, kronična opstruktivna plućna bolest, anksioznost i depresija. Dijagnoza i liječenje teške astme provode se prema GINA smjernicama, u kojima su identifikacija i liječenje komorbiditeta postali integralni dio tretmana astme, a posebice u onim najtežim oblicima bolesti.Patients with severe asthma represent a minority of the total asthma population, but carry a significant healthcare costs and represent a public health problem. Achieving better asthma control in this group of patients is therefore of key importance. Assessment of patients with possible severe asthma to identify triggers of asthma symptoms, including co‐morbidities, improves asthma control. Comorbidities are common in severe asthma and they have a significant impact on prognosis. They are also increasingly recognized as important determinants of asthma phenotypes and characterization of such phenotypes help to establish more appropriate algorithms for assessment, treatment and follow-up of this disease. Most common co‐morbidities in severe asthma are allergic rhinitis, chronic rhinosinusitis, nasal polyposis, dysfunctional breathing, vocal cord dysfunction, obesity, obstructive sleep apnoea, gastroesophageal reflux disease, bronchiectasis, chronic obstructive pulmonary disease, anxiety and depression. Diagnosis and treatment is recommended by GINA guidelines on management of severe asthma. Identification and treatment of comorbidities is now recognized as an integral part of core management of asthma, particularly in the more severe forms of the disease