DISTINCT patterns of multimorbidity in patients with severe asthma have been identified across Europe, offering new insights into how comorbidities cluster and influence disease severity and treatment needs.
Severe Asthma and Multimorbidity
Severe asthma is a complex condition characterised by persistent symptoms, frequent exacerbations, and reduced lung function despite high-intensity therapy, often complicated by multiple coexisting conditions.
A large pan-European analysis of 2,690 patients from 11 countries examined how common comorbidities co-occur in severe asthma. Researchers found that multimorbidity is not random but instead forms recognisable and reproducible patterns across different European regions, suggesting underlying clinical phenotypes.
Three Consistent Comorbidity Clusters Identified
Across all regions studied, three stable comorbidity clusters were observed.
The first linked osteoporosis with steroid-induced weight gain, highlighting the long-term effects of corticosteroid exposure.
The second combined eczema and allergic rhinitis, reflecting an allergic or atopic profile.
The third grouped chronic sinusitis with nasal polyps, indicating a strong upper airway disease association.
Other conditions, including obesity, bronchiectasis, gastro-oesophageal reflux disease, and psychological factors, showed more variable clustering patterns, reinforcing the heterogeneity of severe asthma presentations.
Distinct Multimorbidity Phenotypes Linked to Outcomes
Patients were grouped into multimorbidity phenotypes based on these clustering patterns. The most common phenotype included sinonasal disease without strong cluster alignment, while another large group showed no clear pattern.
Importantly, a steroid-associated multimorbidity phenotype was linked to the worst clinical outcomes, including higher maintenance oral corticosteroid use, poorer lung function, worse asthma control, and more frequent exacerbations.
A separate “maximal multimorbidity” group showed high comorbidity burden alongside increased need for biologic therapies.
Implications for Respiratory Clinicians
For clinicians managing severe asthma, these findings highlight the importance of recognising multimorbidity patterns rather than treating comorbidities in isolation. Patients with steroid-linked multimorbidity may require earlier consideration of steroid-sparing strategies and closer monitoring for systemic complications.
The study suggests that severe asthma should be approached as a whole-patient disease, where comorbidity clustering can help guide personalised treatment strategies and improve long-term outcomes.
Reference
Freeman A et al. Multimorbidity phenotypes and associated characteristics in severe asthma: an observational study of European severe asthma registries. Lancet Reg Health Eur. 2026;63:101600.
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