Comorbidities that influence the control of or mimic severe asthma

Abstract

Severe asthma is characterized by persistent symptoms despite adequate use of high-dose medications, making it essential to exclude differential diagnoses and identify comorbidities that impair disease control. Comorbidities affecting asthma control include allergic rhinitis, gastroesophageal reflux, obesity, psychiatric disorders, smoking, and obstructive sleep apnea, with proper management improving therapeutic response and reducing exacerbations. Conditions that can mimic severe asthma include COPD, heart failure, airway malacia, vocal cord dysfunction, chronic respiratory infections, ABPA, and eosinophilic granulomatosis with polyangiitis. Accurate differentiation between asthma and these conditions is crucial, using tests such as spirometry, body plethysmography, dynamic CT, polysomnography, biomarkers, and laryngoscopy. Studies indicate that asthma-COPD overlap is common, OSA is prevalent in uncontrolled asthma, and ABPA can occur regardless of asthma severity. Individualized, multidisciplinary, evidence-based management is essential to improve disease control, reduce hospitalizations, and avoid inappropriate treatments.