Multimorbidity medications and poor asthma prognosis

Abstract

Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis.We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life).The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: "Few multimorbidity-related medications" (43.5%), "Predominantly allergic multimorbidity-related medications" (32.8%) and "Predominantly metabolic multimorbidity-related medications" (23.7%). Compared with women belonging to the "Few multimorbidity-related medications" profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life.The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.

Risk of adult‐onset asthma increases with the number of allergic multimorbidities and decreases with age

“…Our data, including 10% of adults with severe asthma, suggest that allergic multimorbidity might be more strongly associated with severe asthma than milder form of asthma, although asthma severity was not identified as a significant modifier effect given the large confidence intervals. Our results are in line with results from previous publications . Among adult women with asthma, a clustering approach using drug‐based administrative databases identified three multimorbidity patterns associated with asthma, including a pattern mainly characterized by “allergic multimorbidity” that represented 33% of the population .…”

“…31 This multimorbidity profile showed an increased risk of subsequent uncontrolled asthma and asthma exacerbations as compared to a profile characterized by "few multimorbidity," and importantly, this risk was of similar magnitude than the risk observed for the "metabolic multimorbidity" profile. 31 Thus, allergic diseases affect morbidity lifelong, 32 although in terms of mortality, previous studies indicate that AR/AC did not explain excess mortality among asthmatic adults. 13 Overall, it is likely that asthma with allergic multimorbidity represents phenotypes that considerably differ from asthma alone in terms of mechanisms, severity, and prognosis.…”

“…31 Among adult women with asthma, a clustering approach using drug-based administrative databases identified three multimorbidity patterns associated with asthma, including a pattern mainly characterized by "allergic multimorbidity" that represented 33% of the population. 31 This multimorbidity profile showed an increased risk of subsequent uncontrolled asthma and asthma exacerbations as compared to a profile characterized by "few multimorbidity," and importantly, this risk was of similar magnitude than the risk observed for the "metabolic multimorbidity" profile. 31 Thus, allergic diseases affect morbidity lifelong, 32 although in terms of mortality, previous studies indicate that AR/AC did not explain excess mortality among asthmatic adults.…”

Impact of comorbid conditions on asthmatic adults and children

“…Asthma comorbid conditions are associated with substantial healthcare costs that are five times higher than costs attributable to asthma alone 9 . On top of the direct costs, asthma comorbid conditions are associated with worse asthma-related outcomes 5,10 , increased risk of work disability 11 and significant productivity losses 12 , further contributing to the burden of the disease.…”

Mechanisms of the Development of Allergy (MeDALL) Study: A Systems Medicine Approach to Understand Allergic Diseases

“…There is evidence that these allergic diseases and their multimorbidity in childhood are often associated with further respiratory problems in adult life, such as adult-onset asthma, lower lung function and a higher risk of chronic obstructive pulmonary disease (COPD) [40][41][42] . Further, some population-based studies have observed that those with allergic diseases have a higher prevalence of other noncommunicable diseases (NCDs), specifically cardiovascular and metabolic, both in children 43 and adults 44,45 . In addition, there is consistent evidence from populationbased studies of a significant association between asthma and attention deficit hyperactivity disorder (ADHD) both in children and adults 46,47 .…”