Asthma and Comorbidities: Common, Chronic, and Complex

Chronic comorbid conditions are common in adult asthma patients, and these patients need ongoing support and encouragement from health care providers including pharmacists.

Adult asthma patients who suffer from comorbid chronic conditions tend to experience worse asthma conditions and account for a large portion of emergency department visits for asthma, according to the results of a study published online on August 29, 2013, in Annals of the American Thoracic Society.

For the study, researchers at the University of Michigan, Ann Arbor, analyzed data on 22,172 adults from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2010 to identify asthma patients’ multiple chronic conditions. The researchers were interested in the 5 most common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) and their incidence and demographic distribution in adults with and without asthma. They specifically wanted to determine adverse asthma outcomes experienced by patients who have multiple chronic conditions.

Using NHANES cross-sectional interview data adjusted for body mass index and socioeconomic and demographic factors, the researchers examined associations between diagnoses and adverse outcomes. Approximately 10% of patients in the survey had asthma, and among the asthma patients, 54% had at least 1 comorbidity. The most common comorbid chronic conditions were hypertension and arthritis, which afflicted 34% and 31% of asthma patients, respectively. When the researchers compared asthma patients with non-asthma patients, they found that those with asthma were significantly more likely to have 3 or more comorbid chronic conditions.

Asthma patients who had comorbid chronic conditions were more likely to have symptomatic asthma episodes, and the relative rate of asthma exacerbations increased as the number of comorbidities rose. Other health concerns also increased as the number of comorbid conditions increased. These patients had greater activity limitations, more sleep disturbances, and more frequent asthma-related emergency department visits. The researchers determined that comorbid conditions were associated with up to 20% of emergency room visits for asthma.

These finding have implications for pharmacists. Asthmatic patients who have comorbid health conditions need specific, measurable, and achievable therapeutic endpoints. Pharmacists need to work with patients to review treatment goals, and monitor clinical outcomes at every visit. For optimal outcomes, these patients need ongoing support and encouragement, and a commitment to self-management.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.