A NEWLY developed clinical score has been shown to quantify multimorbidity in difficult-to-treat asthma and predict poor outcomes, supporting a shift toward holistic management of this complex condition.
Researchers used data from the Wessex Asthma Cohort of Difficult Asthma (WATCH) to create the Multimorbidity in Difficult Asthma Score (MiDAS), drawing on patient data collected between 2015 and 2020 from 500 individuals. They first built a modified asthma severity score (m-ASSESS), then analysed the association of 13 common comorbidities with this severity metric. Using a branch-and-bound approach and multivariate regression, they selected seven conditions most strongly linked to asthma severity: rhinitis, gastro-oesophageal reflux disease, breathing pattern disorder, obesity, bronchiectasis, non-steroidal anti-inflammatory drug-exacerbated respiratory disease, and obstructive sleep apnoea. MiDAS was then validated in four international cohorts from Australia, Southeast Asia, and the USA.
The resulting MiDAS scores in the WATCH cohort ranged from 9.6 to 16.2, with a mean of 11.97 (standard deviation: 1.21). Higher scores correlated with poor asthma control (τ=0.31), more frequent exacerbations (τ=0.16), and worse quality of life, as measured by the St George’s Respiratory Questionnaire (r=0.39, p<0.0001). Additionally, MiDAS was associated with elevated proinflammatory markers, including IL-4, IL-5, and leptin. Similar MiDAS values and clinical associations were observed in the international validation cohorts, with mean scores of 12.33 and 12.31 in the Australian groups, 11.80 in the USA cohort, and 11.55 in Singapore. Across these populations, higher MiDAS scores consistently reflected worse asthma control, lower quality of life, and increased prevalence of anxiety, depression, and systemic inflammation.
These findings show that multimorbidity is not only prevalent but clinically significant in patients with difficult-to-treat asthma. MiDAS offers a practical tool to quantify this burden and stratify risk. The evidence points to the need for a broader, multidisciplinary approach to asthma care.
Reference
Kurukulaaratchy RJ et al. Evaluation of the effect of multimorbidity on difficult-to-treat asthma using a novel score (MiDAS): a multinational study of asthma cohorts. Lancet Respir Med. 2025; DOI: 10.1016/S2213-2600(25)00135-3.
