Bronchial asthma and comorbiditiesJ45.9

Bronchial asthma is associated with a number of relevant comorbidities. These must be diagnosed in order to achieve the therapy goals (GINA 2015) with symptom control and control of risk factors for later unfavourable progression (Flick E et al. 2018).

The following relevant comorbities are associated with bronchial asthma (see: AWMF registry number: 020-009):

• Bronchial asthma and gastroesophageal reflux disease: The prevalence of reflux disease is about 1.5 to 2 times higher in asthmatic patients than in non-asthmatic patients (Cazzola M et al. 2011; Havemann BD et al. 2007). Clinically relevant reflux disease should be adequately treated. The treatment of asymptomatic reflux can be based on evidence-based criteria is not recommended according to AMWF guidelines (see: AWMF register number: 020-009).
• Bronchial asthma and obstructive sleep apnea syndrome (OSAS): both conditions are in associated with each other. Obstructive sleep apnea is a possible cause of poor asthma control (Julien JY et al. 2009; Teodorescu M et al. 2010). Thus, treatment of asymptomatic sleep apnea is also recommended to improve asthma-related target parameters. However, it is not sufficiently supported by data (AWMF registry number: 020-009).
• Bronchial asthma and obesity: The association of obesity and asthma is adequately documented epidemiologically. Obesity is associated with increased airway inflammation, increased bronchial hyperresponsiveness, and worsened asthma control, and women appear to be more sensitive (Kim KM et al. 2011; Yoo S et al. 2011; Ciprandi G et al. 2009). For bronchial asthma and atopic dermatitis, this association has been demonstrated in North American and Asian countries, but not in Europe (Zhang A et al. (2015). Obese children have a reduced response to glucocorticosteroid therapy! Insulin resistance is also associated with asthma symptomatology. Successful therapy of marked obesity has a positive effect on the control of bronchial asthma.
• Asthma and mental illness: Anxiety disorders and depression are common in asthma patients. In addition to asthma pathophysiology, they can affect symptom perception, compliance, and service utilization, thus complicating treatment and self-management. In children/adolescents, physical/mental and educational development may be disturbed. Therefore, psychological comorbidities and psychosocial problem constellations should be considered in the medical history and treatment concept and treated if necessary (Chun TH et al. 2008; Katon W et al. 2007; Scott KM et al. 2007).
• Bronchial asthma and dysfunctional breathing: Dysfunctional breathing (e.g. vocal cord dysfunction, VCD: paradoxical, intermittent vocal cord closure with peracute of threatening respiratory distress) and bronchial asthma are associated or difficult to distinguish from each other in epidemiological studies. Dysfunctional breathing should be considered as a possible aggravating factor in difficult bronchial asthma.
• Asthma and endocrinological disorders: Low vitamin D levels and asthma, especially severe asthma, are associated in epidemiological studies. Vitamin D deficiency is often found in patients with asthma. Low vitamin D level is associated with worse lung function in patients with asthma (Ehlayel et al. 2011; Li F et al. 2011). However, it remains unclear to date whether vitamin D administration affects the incidence of asthma. There does not appear to be an association between vitamin D deficiency and atopic dermatitis (Darja K et al. (2017).
• Bronchial asthma and upper respiratory tract diseases: Upper respiratory tract diseases are a risk factor for the development of asthma or can negatively influence the course of asthma. Therapy of allergic rhinitis or asthma can potentially positively influence the other coexisting disease.
• Bronchial asthma and COPD: There is increasing evidence that overlap of COPD and asthma is clinically relevant. Clinically, the "overlap phenotype" can be defined by only incompletely reversible airway obstruction (signs of COPD) in combination with a marked response to bronchospasmolysis or bronchial hyperresponsiveness testing, or as newly diagnosed COPD in patients with pre-existing asthma [Gibson PG et al. 2009; Hardin M et al. 2011). When a patient has similar criteria for asthma or for COPD, the term "asthma-COPD overlap syndrome" (ACOS) is suggested.
• Bronchial asthma and nasal polyps: The combination of nasal polyps and asthma typically occurs as a "late-onset disease", with the same type 2-mediated eosinophilic inflammatory processes in the upper and lower airways. In addition to bronchial hyperreactivity, an increase in sputum eosinophils has also been demonstrated following nasal allergen challenge in patients with allergic rhinitis (AR) (Ciprandi G et al. 2011).
• Bronchial asthma and rhinitis (as well as atopic dermatitis): Bronchial asthma and chronic inflammatory diseases of the upper respiratory tract (rhinitis, sinusitis, polyposis nasi; post-nasal drip syndrome) and skin (atopic dermatitis) are frequently associated (Pinart M et al. 2014). Evidence from epidemiological studies suggests a close association between these conditions (Marple BF 2010).

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