Extrapulmonary associations of health status in severe asthma and bronchiectasis: Comorbidities and functional outcomes

Cordova-Rivera, Laura; Gibson, Péter G.; Gardiner, Paul A.; Hiles, Sarah A.; McDonald, Vanessa M.

doi:10.1016/j.rmed.2019.06.010

Cited by 20 publications

(13 citation statements)

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“…Asthma is a complex heterogenous disease in which individual variability in clinical presentation, disease severity and therapeutic response is common 1,2 . To add to this complexity, behaviours/risk-factors and extrapulmonary comorbidities, also referred to as "Treatable Traits", that are associated with adverse clinical outcomes are common in asthma [3][4][5] . Physical inactivity is one proposed Treatable Trait that is recognised as an important modifiable risk-factor for impaired respiratory functioning, asthma control, quality of life (QoL) and mental health, increased disease severity and exacerbation risk, and ultimately increased healthcare use 6 .…”

Section: Introductionmentioning

confidence: 99%

Increasing physical activity in severe asthma: a systematic review and meta-analysis

et al. 2022

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Introduction/AimPhysical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity (PA) in reducing the risk of these outcomes, little is known about optimal interventions for increasing PA in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing PA in severe asthma.MethodsMedline, CINAHL, EMBASE, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for PA-based intervention studies that assessed PA outcomes (e.g. steps·day−1, time spent undertaking PA) in adults with severe asthma. Data on asthma-related (e.g. asthma control) and health-related outcomes (e.g. HRQoL) were assessed as secondary outcomes. The Revised Cochrane ROB tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible. PROSPERO ID: CRD42021210968ResultsFour RCTs (all 12-weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in PA was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps·day−1 and time spent undertaking PA), and an unsupervised pedometer-based intervention (steps·day−1). Meta-analyses showed that PA interventions had an overall positive effect on steps·day−1 (MD=1588, 95% CI:399, 2778; p=0.009, I2=23), asthma control (MD=-0.65, 95% CI: −0.95, −0.35; p<0.0001, I2=0%), and HRQoL (MD=0.56, 95% CI:0.10,1.01; p=0.02, I2=16%) compared to control.ConclusionWhile there is some evidence supporting the effectiveness of interventions in improving PA in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.

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Section: Introductionmentioning

confidence: 99%

Increasing physical activity in severe asthma: a systematic review and meta-analysis

et al. 2022

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“…6 10 For instance, asthma patients with obesity demonstrated high levels of serum C reactive protein, representing a systemic inflammatory response. 37 Similarly, these inflammatory conditions could influence inner ear inflammation and SSNHL.…”

Section: Discussionmentioning

confidence: 99%

“…This systemic inflammation might be linked to extrapulmonary disorders, including cardiovascular and metabolic diseases 6 10. For instance, asthma patients with obesity demonstrated high levels of serum C reactive protein, representing a systemic inflammatory response 37. Similarly, these inflammatory conditions could influence inner ear inflammation and SSNHL.…”

Section: Discussionmentioning

confidence: 99%

Association of sudden sensorineural hearing loss with asthma: a longitudinal follow-up study using a national sample cohort

et al. 2022

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ObjectiveTo investigate the risk of sudden sensorineural hearing loss (SSNHL) in asthma patients.DesignA longitudinal follow-up study using a retrospective cohortSettingThe 2002–2013 Korean National Health Insurance Service-Health Screening CohortParticipants and interventionsThe ≥40 years old Korean population were enrolled. The asthma patients were 1:1 matched with the control group for age, sex, income and region of residence.Main outcome measureThe occurrence of SSNHL was followed in both asthma and control groups. The stratified Cox proportional hazard model was used. Age, sex, income and region of residence were stratified, and Charlson Comorbidity Index scores, obesity, smoking, alcohol consumption and atopic dermatitis histories were adjusted. Subgroup analysis was performed according to age, sex, obesity, smoking and alcohol consumption.ResultsThe results showed that 1.0% (877/90 564) of the asthma group and 0.8% (706/90,564) of the control group exhibited SSNHL (p<0.001). The asthma group demonstrated a higher HR for SSNHL than the control group (adjusted HR 1.23, 95% CI 1.11 to 1.36, p<0.001). According to age and sex, the female subgroup showed elevated HRs for SSNHL in asthma patients. Both the non-smoker and current smoker groups demonstrated higher HRs for SSNHL in asthma patients than in controls. According to alcohol consumption or obesity, the <1 time a week alcohol consumption group and normal weight and severe obesity groups showed higher HRs for SSNHL in asthma patients than in the controls.ConclusionsAdult asthma patients had a higher risk of SSNHL than the control participants matched for demographic and socioeconomic factors.

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“…To add to this complexity, there are a number of extrapulmonary comorbidities and risk factors, or "traits" that independently affect future asthma outcomes (9)(10)(11). This highlights the importance of individualized asthma management strategies that look beyond the pulmonary system.…”

Section: Introductionmentioning

confidence: 99%

“…This highlights the importance of individualized asthma management strategies that look beyond the pulmonary system. In severe asthma, it has been demonstrated that physical inactivity, symptoms of anxiety and depression, greater systemic inflammation and lower isometric leg strength are independently associated with greater health-related quality of life (HRQoL) impairment ( 9 ). While in another analysis, of the 10 predictors of future exacerbation risk identified in severe asthma, eight were extrapulmonary traits; depression, anxiety, obstructive sleep apnea (OSA), vocal cord dysfunction (VCD), upper airway disease, systemic inflammation, underweight, and inhaler device polypharmacy ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma

McLoughlin

McDonald

2021

Front. Allergy

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Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or “traits,” which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.

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Extrapulmonary associations of health status in severe asthma and bronchiectasis: Comorbidities and functional outcomes

Abstract: Tertiles of high-sensitivity C-reactive protein Sarcopenia absent vs. present Tertiles of steps/day Tertiles of isometric leg strength

Cited by 20 publications

References 56 publications

Increasing physical activity in severe asthma: a systematic review and meta-analysis

Increasing physical activity in severe asthma: a systematic review and meta-analysis

Association of sudden sensorineural hearing loss with asthma: a longitudinal follow-up study using a national sample cohort

The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma

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