Personalized asthma strategies needed to tackle comorbidities

Published on December 31, 2013 at 9:15 AM · No Comments

By Kirsty Oswald, medwireNews Reporter

Results from a German national health survey indicate that asthma patients with multiple comorbidities are at increased risk for unplanned hospital admissions.

The findings also confirm that comorbidities among asthma patients are common, with cardiovascular disease and depression overrepresented compared with the general population.

Study authors Henriette Steppuhn (Robert Koch Institute Berlin, Germany) and colleagues say the results highlight that many asthma patients have complex healthcare needs and treatment strategies for different combinations of disease are needed in clinical practice.

“Apart from additive effects resulting from the interaction between disease processes or drug interactions, the effects of multiple co-morbidities on patient self-management as well as other aspects of patient complexity such as depression and social factors need to be considered,” they comment.

The team used data from the 2009 and 2010 German Health Update survey, including 43,312 people of whom 2242 (5.3%) had current asthma. During the interview, respondents were asked whether they had or had ever experienced any of eight common chronic conditions: Type 2 diabetes, hypertension, coronary heart disease (CHD), chronic heart failure (CHF), stroke, cancer, osteoarthritis, and depression.

Overall, respondents with asthma were significantly more likely to have at least one of these conditions, compared with respondents without asthma, at 61.1% versus 43.0%. In multivariate analysis, patients with asthma also had significantly greater odds for each condition individually, apart from cancer, with the most pronounced increased risk for cardiovascular diseases (CHF: odds ratio [OR]=2.74; CHD: OR=2.14; stroke: OR=2.12) and depression (OR=2.06).

Analysis of a subset of 1136 asthma patients from the 2010 survey showed that asthma-related hospital visits were common. In the prior 12 months, 46.4% had experienced at least one urgent care visit, 9.0% had at least one hospitalization and/or emergency department visit, and 45.3% had at least one unscheduled outpatient care visit.

The likelihood of both unscheduled inpatient and outpatient care increased with the number of comorbidities. In particular, patients with three or more comorbid conditions had a 3.40- and 2.32-fold increased odds for each type of admission, respectively, compared with patients with no comorbidities. Patients with two comorbid conditions also had a 1.86-fold increased risk for unscheduled outpatient care, but having only one comorbid condition was not significantly associated with unscheduled visits.

Writing in the Primary Care Respiratory Journal, Steppuhn and colleagues say that, to date, the issue of comorbidities in asthma has been largely disregarded, and has received little attention in clinical guidelines.

“Further research is needed to gain insight into the mechanisms underlying the observed independent association between asthma and various other chronic diseases – in particular cardiovascular conditions and depression – and to identify the specific healthcare needs of patients with asthma in the presence of specific co-morbidities,” they conclude.

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