Severe Asthma Multimorbidity Clusters Across Europe; Findings From SHARP

Abstract

Background: The nature and impact of multimorbidity (MM) in severe asthma (SA) is poorly defined.

Aim: To better understand this issue we applied cluster analysis to create MM clusters in SA from comorbidities across the SHARP CRC.

Methods: We analysed data from 2690 patients in 11 SHARP CRC countries spanning North, East, South and Western Europe.

Results: Ten comorbidities had prevalence ≥5% in all regions. Three MM clusters (MMC) based on 6 conditions were consistently seen across Europe: MMC1) osteoporosis and steroid induced weight gain, MMC2) eczema and rhinitis, and MMC3) chronic sinusitis and nasal polyps. Obesity, bronchiectasis, gastro-oesophageal reflux and psychological comorbidities clustered variably by region (Fig. 1).

Patients were categorised according to whether their comorbidity profile fell into none, 1, 2 or all 3 of these MMC groups (giving 8 possibilities; MMC0 through to MMC123). MMC3 (25%) was the commonest single group and had highest T2 traits. MMC0 (19%) had oldest asthma onset and was more likely to currently smoke. MMC1 (8%) had highest regular oral steroid use, worst lung function and highest BMI. Prevalence of the 8 MMC groups varied by country.

Conclusion: We found 3 consistent MM clusters in SA across Europe, plus 4 comorbidities that varied in cluster assignment by region. MMC prevalence varied by country, but patients profiled in this way had consistent and distinct clinical traits.