Nonrespiratory conditions in asthma


Dr Surya Kant, Professor and Head, Dept. of Respiratory Medicine, KGMU, UP, Lucknow. National Vice Chairman IMA-AMS    30 January 2023

Adult patients with asthma are more likely to have nonrespiratory diseases compared to adults without asthma, says a study published in The Journal of Allergy and Clinical Immunology: In Practice.1 Late age at diagnosis of asthma was associated with multiple comorbidities.


For this study conducted in 2016, the FinEsS questionnaire was sent to randomly selected 16,000 Finnish people with ages ranging from 20 years to 69 years; 8199 (51.5%) replied to the questionnaires. 879 reported physician-diagnosed asthma and of these, 842 (10.3%) also reported the age at diagnosis of asthma as early (0-11 years), intermediate (12-39 years) and late-diagnosed (40-69 years). The questionnaire also included questions about allergic rhinitis, COPD, asthma treatment and 14 nonrespiratory diseases (hypertension, arrhythmia, heart failure, coronary artery disease, stroke or TIA, depression, anxiety or panic disorder, diabetes, GERD, chronic kidney failure, sleep apnea, osteoporosis, painful condition, and obesity) and relevant risk factors including occupational factors.


Among participants with physician-diagnosed asthma, GERD was the most prevalent nonrespiratory disease in those with early-onset asthma, with odds ratio (OR) of 1.93 compared to subjects without asthma. Amongst the intermediate-diagnosed and late-diagnosed asthma, the most common nonrespiratory condition was osteoporosis with OR of 3.45 and 2.91, respectively. Obesity was more prevalent among the early- and intermediate-diagnosed asthma.


Anxiety or panic disorder were more common among participants with intermediate-diagnosed asthma. Subjects with late-diagnosed asthma had greater prevalence of COPD, hypertension, severe cardiovascular disease, arrhythmia and diabetes compared to those who did not have asthma. However, the associations mostly disappeared after further adjusting for smoking, COPD and BMI.


Depression, sleep apnea, painful conditions necessitating the use of a painkiller was more common in the intermediate- or late-diagnosed asthma group in comparison to subjects without asthma.


Nearly 60% of patients with physician-diagnosed asthma and 47% of those with no asthma had ≥1 nonrespiratory conditions. In the intermediate-diagnosed asthma, 12% patients reported ≥3 nonrespiratory conditions, while this number increased to 36% among those with late-diagnosed asthma; just 10% of subjects without asthma had ≥3 nonrespiratory conditions,


These findings show that nonrespiratory conditions were more frequent among patients with asthma than those with no asthma. Moreover, the number of nonrespiratory conditions increased as the age at diagnosis of asthma increased. In this age of personalized medicine, this study urges the clinician to take a holistic and patient-centric approach to asthma management which includes assessment and management of coexisting conditions for better patient outcomes.





Honkamäki J, et al. Nonrespiratory Diseases in Adults Without and With Asthma by Age at Asthma Diagnosis. J Allergy Clin Immunol Pract. 2022 Nov 2:S2213-2198(22)01067-4

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