Management of comorbidities in difficult and severe asthma

Abstract

Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians’ assessment of asthma treatment efficacy.

The role of radiological imaging in the management of severe and difficult-to-treat asthma

“…It is important to distinguish asthma that is difficult to treat due to comorbidities from true severe asthma, hence the need for appropriate investigations in asthma management [ 3 ]. Comorbidities in DTA are wide ranging and include chronic rhinosinus diseases, COPD, bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA), eosinophilic granulomatosis with polyangiitis (EGPA), eosinophilic pneumonia, inducible laryngeal obstruction (ILO), and excessive dynamic airway collapse (EDAC) [ 4 ]. Mimickers of asthma conditions, such as ILO and EDAC, can coexist with asthma or be the exclusive main diagnosis that drives symptoms [ 5 ].…”