Multimorbidity phenotypes and associated characteristics in severe asthma: an observational study of European severe asthma registries
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: The phenotypic nature of multimorbidity in severe asthma is poorly understood. Our aims in this study were to define multimorbidity phenotypes and their characteristics in severe asthma across Europe by identifying and characterising co-aggregation of comorbidities. Methods: Cross-sectional patient data were analysed from the pan-European Severe Heterogenous Asthma Research Collaboration: Patient Centred (SHARP) Central database of national severe asthma registries. Patients were grouped by four European regions (North, South, East, and West). Hierarchical clustering of comorbidities was applied to characterise the correlation structure of the ten commonest comorbidities within these geographical regions. Subsequent multimorbidity phenotypes (MMP) and their clinical features were then defined. Findings: Data were available for 2690 severe asthma patients and 23 comorbidities from 11 countries. Three comorbidity clusters were consistently seen across the four European regions: 1) osteoporosis plus steroid-induced weight gain, 2) eczema plus rhinitis, and 3) chronic sinusitis plus nasal polyps. Four further comorbidities (obesity, bronchiectasis, gastro-oesophageal reflux disease, psychological factors) showed variable clustering. Multimorbidity was ubiquitous. Patients were assigned multimorbidity phenotypes (MMP) according to comorbidity cluster alignment. MMP sn (sinonasal-associated) and MMP u (no specific cluster alignment) were commonest. MMP ster (steroid-associated multimorbidity) had highest maintenance oral steroid (m-OCS) use, and Body Mass Index, plus worst lung function, asthma control, and asthma exacerbation frequency. MMP max (maximal multimorbidity) showed high prevalence of variably assigned comorbidities, higher m-OCS and biologic treatment needs. Interpretation: Multimorbidity is common in severe asthma and can be classified into replicable novel phenotypes with characteristic clinical traits and outcomes. Recognising these phenotypes can guide better care of the 'whole patient' with severe asthma. Future clinical guidance should promote such understanding in order to support delivery of more effective personalised asthma care. Funding: European Respiratory Society, pharmaceutical industry partners (Sanofi, TEVA, Novartis, GlaxoSmithKline, Chiesi).
Authors: Anna Freeman, Saša Rink, Aruna T. Bansal, Betty Frankemölle, Mehar Singh, Jacob K. Sont, Apostolos Bossios, Ben Ainsworth, Michael Hyland, Rekha Chaudhuri, Dace Matisa, Florin Mihaltan, Antonio Spanevello, Enrico Heffler, Ian Adcock, Martina Zappa, Giorgio Walter Canonica, Guy Brusselle, Arnaud Bourdin, Giulia Anna Maria Luigia Costanzo, Ildiko Horvath, Dóra Lúðvíksdóttir, Stefania Principe, Peter Kopač, Cláudia Chaves Loureiro, Salman Siddiqui, Arne Egesten, Virginija Kalinauskaite-Zukauske, Sanja Dimic-Janjic, Graham Roberts, Sanja Hromis, Branislava Milenkovic, Judit Varkonyi-Sepp, Ozlem Goksel, Ana M. Pereira, Ratko Djukanovic, Angela Rizzi, Marco Caminati, Ruihua Hou, Anamarija Štajduhar, Dóra Paróczai, Luisa Brussino, Liam Heaney, Hans Michael Haitchi, Matteo Bonini, Kristina Bieksiene, Ebru Damadoglu, Valentyna Yasinska, Bilun Gemicioglu, Sanja Popović Grle, Anneke ten Brinke, Zsuzsanna Csoma, Iveta Kroica, Piotr Kuna, Barbro Dahlen, Celeste Porsbjerg, Hilary Hodge, Sabina Škrgat, Florence Schleich, Ramesh J. Kurukulaaratchy
Institutions: University Hospital Southampton NHS Foundation Trust, National Institute for Health and Care Research, NIHR Southampton Biomedical Research Centre, University of Southampton, University of Ljubljana, Ljubljana University Medical Centre, European Lung Foundation, Leiden University, Leiden University Medical Center, Karolinska University Hospital, Karolinska Institutet, University of Plymouth, University of Glasgow, Riga East University Hospital, University of Insubria, Istituti Clinici Scientifici Maugeri, Humanitas University, IRCCS Humanitas Research Hospital, Imperial College London, Ghent University Hospital, Centre National de la Recherche Scientifique, Inserm, Université de Montpellier, Physiologie et Médecine Expérimentale du Coeur et des Muscles, Hôpital Arnaud de Villeneuve, University of Cagliari, Országos Korányi Tbc és Pulmonológiai Intézet, University of Iceland, National University Hospital of Iceland, Amsterdam University Medical Centers, Unidade Local de Saúde de Coimbra, Lund University, Skåne University Hospital, Lithuanian University of Health Sciences, University of Belgrade, Univerzitetski Klinički Centar Srbije, St Mary's Hospital, David Hide Asthma and Allergy Research Centre, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Southern Health NHS Foundation Trust, Ege University, Universidade do Porto, CUF Porto Hospital, Centre for Health Technology and Services Research, RISE - Health Research Network, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, University of Verona, University Hospital Centre Zagreb, University of Zagreb, University of Szeged, University of Turin, Queen's University Belfast, Sapienza University of Rome, Hacettepe University, Istanbul University-Cerrahpaşa, Istanbul University, Medisch Centrum Leeuwarden, Medical University of Lodz, University of Copenhagen, Bispebjerg Hospital, University of Liège
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
OpenAlex ID: W7127961563