Asthma and comorbid medical illness

Cazzola, Mario; Calzetta, Luigino; Bettoncelli, Germano; Novelli, Lucia; Cricelli, Claudio; Rogliani, Paola

doi:10.1183/09031936.00140310

Cited by 104 publications

(110 citation statements)

References 41 publications

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“…The renal and urinary disorder RRs were slightly higher for COPD patients (RR 1.53, 95% CI 1.3-1.7) than asthma patients (RR 1.37, 95% CI 1.1-1.6) [29]. The results of a more recent study indicate that asthma is weakly associated with diabetes mellitus, dyslipidemia, and cardiovascular and hypertensive disease [32]. Although asthma has been proposed to have many comorbidities [29][30][31][32], its association with CKD has not been entirely elucidated, and the underlying mechanisms remain unknown.…”

Section: Discussionsupporting

confidence: 48%

“…The results of a more recent study indicate that asthma is weakly associated with diabetes mellitus, dyslipidemia, and cardiovascular and hypertensive disease [32]. Although asthma has been proposed to have many comorbidities [29][30][31][32], its association with CKD has not been entirely elucidated, and the underlying mechanisms remain unknown. Further research is needed to determine the interrelationships between COPD, asthma, and CKD.…”

Section: Discussionmentioning

confidence: 96%

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C-reactive protein levels, airflow obstruction, and chronic kidney disease

Funakoshi

Omori

Mihara

et al. 2011

Environ Health Prev Med

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Objectives There is some evidence that chronic obstructive pulmonary disease and chronic kidney disease (CKD) may be related, perhaps through systemic inflammation, which is common to both. However, this relationshiphas not yet been clearly demonstrated. The aim of this study was to investigate the association between airflow obstruction, CKD, and C-reactive protein (CRP) levels in Japanese men. Methods The study included 11,587 men, aged 40-88 years, who underwent a health check-up. Airflow obstruction was defined as a forced expiratory volume in 1 s/forced vital capacity of \70%, and its severity was based on the Global Initiative for Chronic Obstructive Lung Disease guidelines (GOLD). CKD was defined as an estimated glomerular filtration rate of \60 mL/min/1.73 m 2 . Results Airflow obstruction was present in 7.9% of the participants, and 10.6% of the participants had CKD. The average CRP levels were 0.11 ± 0.36, 0.13 ± 0.41, and 0.18 ± 0.41 mg/L for subjects with normal lung function, GOLD stage I, and GOLD stage II-IV, respectively. With regard to CKD, the average CRP levels were 0.11 ± 0.32 and 0.18 ± 0.6 mg/L for subjects without and with CKD, respectively. Analysis of covariance showed no significant differences between the CRP level and lung function status or CKD after age was adjusted for. Logistic regression analysis showed no association among subjects with the three different lung function statuses after age, body mass index, hypertension, diabetes, hyper-low-density-lipoprotein-cholesterolemia, smoking, physical activity, and alcohol intake were controlled for. Conclusions Based on the results of this study, we conclude that there is no interrelationship between CRP level, airflow obstruction, and CKD.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 96%

C-reactive protein levels, airflow obstruction, and chronic kidney disease

Funakoshi

Omori

Mihara

et al. 2011

Environ Health Prev Med

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“…This is mainly due to the presence of comorbidities that may represent exclusion criteria for RCTs of COPD [1]. In asthma, the association with comorbidities only partially resembles that of COPD: on the one hand, a coexistence with cardiovascular diseases, cerebrovascular diseases, depression, diabetes mellitus, dyslipidaemia, or osteoporosis is less frequent [2]; on the other hand, asthma is strongly associated with allergic rhinitis and gastro-oesophageal reflux disease [2], which are not considered exclusion criteria for RCTs. Most importantly, because cigarette smoking is associated with asthma instability, an increased exacerbation rate, and impaired lung function, active cigarette smoking is often a requisite for exclusion from RCTs of asthma [3].…”

Section: Introductionmentioning

confidence: 99%

Are Asthmatics Enrolled in Randomized Trials Representative of Real-Life Outpatients?

et al. 2015

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Background/Objective: This study was aimed at exploring to what extent populations enrolled in randomized controlled trials (RCTs) of inhalation combination treatment for mild/moderate asthma in adults are fully representative of ‘real-life' populations. The following is a retrospective analysis of the clinical records of outpatient subjects with an ascertained diagnosis of asthma. Methods: A retrospective analysis was performed. Stable conditions, such as smoking habit and chronic diseases other than asthma, were identified as exclusion criteria for RCTs. The selected criteria were then applied to asthmatic outpatients, yielding a population that was potentially eligible for RCTs. Results: Out of 1,909 subjects, 824 (43.2%) met at least one of the exclusion criteria for RCTs. Cigarette smoking (occurring in 34.3% of the entire population), lung diseases other than asthma (5.0%), anxiety and depression (3.3%), arrhythmias (2.3%), and coronary artery disease (1.2%) would have been the most frequent causes for exclusion from RCTs. The proportion of patients excluded from RCTs appears to increase with age, reaching 57.1% in patients aged >85 years. Conclusions: In a real-life setting, >40% of subjects with mild/moderate asthma are currently treated by protocols based on the results of RCTs for which they would not have been eligible. This proportion increases in elderly patients with comorbidities. These findings limit the generalizability of RCTs and advocate that complementary pragmatic studies be conducted.

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“…Consistently with international reports [7][8][9][10], allergists are aware that risk factors and co-morbidities may impact on the natural history of asthma, leading to symptoms worsening and reduced treatment efficacy, thus identifying patients who need a more careful and strict monitoring to maintain control. It is intriguing that rhinitis and smoking habits are considered less impactful on asthma control than nocturnal apneas and obesity: possibly, the latters are regarded as risk factors/comorbidities which are more difficult to control or cure.…”

Section: Discussionmentioning

confidence: 67%