D2.114 - Insights from the BREATHE Study: Comorbidity Burden and Biomarker Trends in Severe Asthma Patients

Severe asthma (SA) is a heterogeneous disease associated with a significant burden of comorbidities that impact disease control and treatment outcomes. BREATHE is a two-year ambispective, multicenter cohort study conducted in Spain, designed to assess the evolution of disease burden in SA patients. This report focuses on the comorbidity burden and biomarker trends.

BREATHE study included 344 SA patients from 21 Spanish centers who met the following criteria: confirmed SA diagnosis, high-dose of inhaled corticosteroids (ICS) + long-acting adrenergic b2-agonists (LABA) for ≥6 months before inclusion, and ≥12 months of documented clinical history. Data were collected across the following time points: 12 months prior to the index date, at index, and 6 and 12 months post-index. 

Patients had a mean age of 53.1±14.5 years, 229 (66.6%) were female, and 312 (90.7%) presented general and/or respiratory comorbidities (Table 1). The most common respiratory comorbidities included allergic rhinitis (44.3%), CRSwNP (41.7%), CRSsNP (21.9%), nonsteroidal anti-inflammatory drugs (NSAIDS) hypersensitivity (16.2%), obstructive sleep apnea (14.5%), bronchiectasis (11.4%), and chronic rhinitis (10.1%). The most common general comorbidities were hypertension (29.3%), gastroesophageal reflux disease (27.9%), obesity (26.6%), anxiety (17.9%), and depression (15.3%). The group of patients with allergen-driven asthma contained a significantly higher number of individuals with blood eosinophils count (BEC) ≥150 cells/µl (p=0.0005), with FeNO≥40 ppb (p=0.0253) and presented significantly higher IgE levels (p=0.0465). Patients with allergic rhinitis were also enriched in BEC≥150 cells/µl (p=0.0215) and displayed higher IgE levels (p=0.0033). Presence of atopic dermatitis correlated with higher IgE levels (p=0.0040), while NSAIDS hypersensitivity and bronchiectasis correlated with FeNO≥40 ppb (p=0.0409 and p=0.0245, respectively). Confidence interval widths and p-values are unadjusted for confounders or multiplicity.

Comorbidities contribute significantly to the disease burden in SA. Allergen-driven asthma have higher levels of eosinophils, IgE and FeNO than non-allergic asthma. Patients with bronchiectasis or NSAIDs hypersensitivity have higher FeNO levels. These relationship between the presence of certain comorbidities and biomarker levels is essential to understand all the factors affecting the disease and the selection of treatment.