Asthma Control in Multimorbid Patients

Ludmila V. Tribuntseva, Andrey V. Budnevsky, Galina G. Prozorova, Svetlana A. Kozhevnikova, Irina A. Olysheva, Evgeniy S. Ovsyannikov, Tatiana A. Chernik

International Journal of Biomedicine. 2023;13(1):37-40.
DOI: 10.21103/Article13(1)_OA2
Originally published March 3, 2023


Background: The aim of this study was to evaluate the asthma control in multimorbid patients to personalize asthma treatment.
Methods and Results: The study involved 237 asthma patients (51 men and 186 women) aged 18 to 78 years (mean age of 52.6±1.3 years). All patients were divided into 3 groups: Group 1 included 59(24.9%) patients with normal body weight (NVW), Group 2 included 69(29.1%) overweight patients, and Group 3 had 109(46.0%) obese patients. The mean BMI was of 23.14±2.84 kg/m2, 27.60±2.58 kg/m2, and 35.82±10.23 kg/m2 in Groups 1, 2, and 3, respectively (F=65.572, P=0.0000). Research methods included numerical rating scale (NRS) for a qualitative assessment of the severity of asthma clinical symptoms, asthma control questionnaire (ACQ-5) to assess asthma control, asthma quality of life questionnaire (AQLQ). Comorbidities were analyzed according to medical records.
The mean number of comorbidities among all studied patients was 4.31±0.27: 55(23.2%) people had ≤2 comorbidities, 118(49.8%) people had 3-5 comorbidities, and 64(27.0%) people had ≥6 comorbidities. The Group 3 patients had significantly more comorbidities than patients of Groups 1 and 2 (P=0.000). The mean value of the ACQ-5 results was 0.97±0.32, 1.06±0.53, and 1.82±0.55 in Groups 1, 2, and 3, respectively (F=77.1896, P=0.0000). The level of AC, according to the ACQ-5, had a positive correlation with the number of comorbidities (r=0.5418, P<0.05) and a negative correlation with all scales of the AQLQ: activity limitation (r=-0.6376, P<0.05), symptoms (r=-0.6577, P<0.05); emotional function (r=-0.4535, P<0.05); environmental stimuli (r=-0.4529, P<0.05), and general QOL (r=-0.6504, P<0.05).
The asthma course is negatively affected by multimorbidity, which is most pronounced in obese patients. An increase in the number of comorbidities significantly worsens AC in patients of all studied groups, while the worst control level was observed in obese patients. A personalized program for managing multimorbid asthma patients should be developed and implemented, considering the multivariate assessment of treatable signs of disease.

asthma control • multimorbidity • body mass index
  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021.Available from:
  2. Arkhipov VV, Grigoryeva EV, Gavrishina EV. [Control of bronchial asthma in Russia: results of NIKA multi-center observational study]. Pulmonologiya. 2011;(6):87-93. (In Russ.) doi: 10.18093/0869-0189-2011-0-6-87-93. [Article in Russian].
  3. Mindlis I, Wisnivesky JP, Wolf MS, O'Conor R, Federman AD. Comorbidities and depressive symptoms among older adults with asthma. J Asthma. 2022 May;59(5):910-916. doi: 10.1080/02770903.2021.1887890.
  4. Van Huisstede A, Castro Cabezas M, van de Geijn GJ, Mannaerts GH, Njo TL, Taube C, Hiemstra PS, Braunstahl GJ. Underdiagnosis and overdiagnosis of asthma in the morbidly obese. Respir Med. 2013 Sep;107(9):1356-64. doi: 10.1016/j.rmed.2013.05.007.
  5. Stepanova YeV, Loranskaya ID, Rakitskaya LG, Mamedova LD. [Obesity as the Omni-Factor for Serious Diseases]. Effektivnaya Farmakoterapiya. 2019;15(18):68-77. doi: 10.33978/2307-3586-2019-15-18-68-77. [Article in Russian].
  6. Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest. 1999 May;115(5):1265-70. doi: 10.1378/chest.115.5.1265. 
  7. Weatherburn CJ, Guthrie B, Mercer SW, Morales DR. Comorbidities in adults with asthma: Population-based cross-sectional analysis of 1.4 million adults in Scotland. Clin Exp Allergy. 2017 Oct;47(10):1246-1252. doi: 10.1111/cea.12971.
  8. Wardzyńska A, Kubsik B, Kowalski ML. Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment. Geriatr Gerontol Int. 2015 Jul;15(7):902-9. doi: 10.1111/ggi.12367.
  9. Cazzola M, Rogliani P, Ora J, Calzetta L, Matera MG. Asthma and comorbidities: recent advances. Pol Arch Intern Med. 2022 Apr 28;132(4):16250. doi: 10.20452/pamw.16250.
  10. Ermolova AV, Budnevsky AV, Yu ME, Ovsyannikov ES, Drobysheva ES. [BRONCHIAL ASTHMA AND METABOLIC SYNDROME]. Klin Med (Mosk). 2015;93(6):44-9. [Article in Russian].
  11. Provotorov VM, Budnevsky AV, Filatova YI. [Clinical manifestations of asthma during combination therapy using ceruloplasmin]. Ter Arkh. 2016;88(3):36-39. doi: 10.17116/terarkh201688336-39. [Article in Russian].
  12. Provotorov VM, Budnevsky AV, Filatova YI, Perfil'eva MV. [ANTIOXIDANT THERAPY OF BRONCHIAL ASTHMA]. Klin Med (Mosk). 2015;93(8):19-22. [Article in Russian].
  13. Budnevsky AV, Isaeva YV, Malysh EY, Kozhevnikova SA. Legochnaya reabilitatsiya kak effektivnyi metod optimizatsii lechebno-profilakticheskikh meropriyatii u bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh s metabolicheskim sindromom [Pulmonary rehabilitation as an effective method for optimizing therapeutic and preventive measures in patients with chronic obstructive pulmonary disease concurrent with metabolic syndrome]. Ter Arkh. 2016;88(8):25-29.  doi: 10.17116/terarkh201688825-29. [Article in Russian].
  14. Tsvetikova LN, Budnevsky AV, Ovsyannikov ES, Kudashova EA. Melatonin: Possibilities for use in the treatment of asthma. Ter Arkh. 2017;89(3): 112–115. (In Russ.) doi: 10.17116/terarkh2017893112-115.
  15. Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MÁ. Obesity hypoventilation syndrome. Eur Respir Rev. 2019 Mar 14;28(151):180097. doi: 10.1183/16000617.0097-2018.
  16. Tomisa G, Horváth A, Sánta B, Keglevich A, Tamási L. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol. 2021 Sep 22;17(1):95. doi: 10.1186/s13223-021-00598-3.

Download Article
Received November 19, 2022.
Accepted December 12, 2022.
©2023 International Medical Research and Development Corporation.