Asthma Comorbidities

Comorbidities are health conditions that occur alongside each other. They are sometimes called comorbid conditions. The conditions may be related to each other in some way. For example, they may have the same causes or risk factors. Other times, each condition occurs separately, but they make each other worse.¹

Many comorbidities of asthma can make it harder to diagnose, manage, or treat your asthma. This is because the symptoms of the comorbidity might mimic asthma. Or treating the comorbidity might make your asthma worse.^1,2

Having a comorbid condition along with asthma leads to poorer health outcomes and quality of life. The good news is that treating these conditions can improve outcomes.^1,2

How common are asthma comorbidities?

Estimates vary, but at least 60 percent of people with asthma likely have at least 1 comorbidity. These conditions are even more common in people with severe or hard-to-control asthma. In fact, 1 study found that in people with severe asthma:^1,3,4

• Over 90 percent have at least 1 comorbidity
• More than half have 3 or more comorbidities

The number of comorbid conditions a person has tends to increase with age. Other groups with asthma who have an especially high risk for comorbidities include:^1,3

• Older women
• People who used to smoke
• People who rely on prednisone to treat their asthma

People with comorbidities may have more asthma attacks and have to use more medicine to control the attacks. They also may have to take multiple drugs to manage all their conditions. Sometimes, these drugs cause further health problems. In general, people with asthma comorbidities tend to have:^1,2

• Higher healthcare costs
• More doctor visits
• More hospital visits

What causes asthma comorbidities?

Some comorbid conditions stem from the same factors that cause asthma. For example, 1 major shared factor is inflammation in the airways. Conditions that share this factor with asthma include allergic rhinitis and chronic rhinosinusitis.^3,4

Other comorbidities have similar symptoms as asthma and can make asthma worse. Gastroesophageal reflux disease (GERD) is an example of this kind of condition.⁴

What are the most common comorbidities of asthma?

Asthma comorbidities can be grouped as pulmonary or extrapulmonary. Pulmonary conditions affect the lungs and airways. Extrapulmonary conditions affect other parts of the body or the whole body. Both kinds of comorbidity can complicate your asthma:²

• Symptoms
• Diagnosis
• Treatment

Pulmonary comorbidities

Pulmonary comorbidities can occur in the upper or lower breathing (respiratory) tract. Because they affect breathing, these conditions may be easy to mistake for asthma. Common pulmonary comorbidities of asthma include:^1-5

• Allergic rhinitis – This condition causes symptoms like nasal stuffiness (congestion), sneezing, and itching inside the nose. It is also called hay fever or seasonal allergies.
• Chronic rhinosinusitis – This condition stems from long-term (chronic) inflammation of the sinuses or nasal passages. Symptoms can include congestion, discharge, or pain in the sinuses.
• Nasal polyposis – About 1 in 5 people with chronic rhinosinusitis also have nasal polyposis. In people with this condition, polyps grow inside the nose or sinuses. Polyps are growths that are not cancer.
• Vocal cord dysfunction – This condition causes the vocal folds to narrow. This can block the airways and cause symptoms like wheezing and chest tightness. The condition is also called inducible laryngeal obstruction.
• Obstructive sleep apnea – Sleep apnea is a condition in which breathing stops for short periods during sleep. In adults with obstructive sleep apnea, this happens because the throat muscles relax, allowing the throat to close up. In children, swollen tonsils or adenoids may be the cause.
• Chronic obstructive pulmonary disease (COPD) – COPD is a serious lung disease that makes it hard to get enough oxygen.
• Bronchiectasis – In this condition, the walls of the airways are weakened and get wider. This widening of the airways leads to a buildup of mucus and increases the risk of infection.

Extrapulmonary comorbidities

Extrapulmonary conditions that occur with asthma can be anywhere in your body or throughout your body. Common extrapulmonary comorbidities of asthma include:^1-4,6

• GERD – In GERD, stomach acid regularly flows backward into the tube between your mouth and stomach (esophagus). This condition can cause symptoms like coughing or wheezing. Over time, it can damage the respiratory tract.
• Obesity – Obesity is having a high body weight for your height. Having obesity can increase inflammation, cause trouble breathing, and make asthma worse. Obesity also can lead to a number of other serious health problems. In people who have obesity, losing weight can improve asthma outcomes.
• Anxiety or depression – Both anxiety and depression are common in people with asthma. These conditions may make people perceive their asthma symptoms as being worse than they are. It can also be that people with mental health conditions have more severe asthma symptoms because they have a harder time sticking to their asthma treatment.
• Osteoporosis – This condition causes the bones to weaken and become brittle. Osteoporosis often results from prolonged use of steroids. People with osteoporosis have a higher risk of bone fractures. And fractures in the ribcage can make it harder to breathe.
• Type 2 diabetes – Diabetes and asthma commonly occur together, especially in women. Diabetes can harm the lungs and reduce their ability to work the way they should.
• Heart disease – People with asthma have a much higher risk of developing heart disease. High blood pressure (hypertension) is the most common heart-related comorbidity of asthma.

Comorbidities in children

Children have slightly different rates of asthma comorbidities than adults do. Children experience many of the same comorbid conditions as adults. But children most commonly live with other allergic (atopic) conditions. These conditions include:⁷

• Allergic rhinitis
• Food allergies
• Eczema or atopic dermatitis

Also, obesity might affect the course of asthma in children more than in adults. It may complicate asthma symptoms more. In people who developed asthma as children, obesity can also make asthma more dangerous. Unfortunately, rates of obesity are quickly rising in children and teenagers.¹

Have you experienced asthma comorbidities? Share your experience with us!