Do Comorbidities Influence the Response to Biologics in Severe Asthma?
Speaker Ramesh Kurukulaaratchy, Southampton (UK)
Multimorbidity, defined as the co-existence of two or more long-term health conditions, is common in severe asthma. Most patients have at least one additional comorbidity on top of their severe asthma, and typically present with 3-4 additional comorbidities.1,3
Burden of multimorbidity
The impact on persons living with severe asthma is huge: comorbidities lead to impaired quality of life, poor asthma control, worse lung function, exacerbations and the use of maintenance oral steroids, consequently making clinical remission difficult to achieve.1 Multimorbidity leads to a high economic cost burden: half of the cost of treating severe asthma comes from other health problems.2
Phenotypes guiding towards holistic treatment
Multimorbidity can be classified into replicable phenotypes with characteristic clinical traits and outcomes.3 These phenotypes can help to guide better care of the “whole person living with asthma”, promoting the delivery of more effective personalised asthma care.
Analyses were presented to answer how multimorbidity links with disease severity and adverse health outcomes in severe asthma patients, and to identify which comorbidities are the most important. Currently eight multimorbidity phenotypes have been described according to comorbidity cluster alignments.3
Disease severity and multimorbid phenotypes
The two phenotype associated with the highest disease severity3 were:
- Steroid-associated multimorbidity – More severe. High smoking history, high use of oral corticosteroids, frequent exacerbations, poor asthma control. High levels of comorbid obesity, bronchiectasis, psychological comorbidity and GERD.
- Maximal multimorbidity: More severe poorly controlled asthma, female predominance, higher blood eosinophil counts, higher use of oral steroids, high steroid-related and other comorbidity burden.
Multimorbidity phenotypes with more beneficial prognosis3 have also been identified, such as
- Sinonasal-associated multimorbity: Better controlled later asthma onset, higher male prevalence, high T2 traits, better lung function, lower OCS-related comorbidity. More airway-centric phenotype.
- Allergy and Sinonasal-assocoated multimorbidity: Better controlled asthma, strong T2-traits, lower smoking history, preserved lung function.
MiDAS score for assessing impact of multimorbidity
From their insights, the authors developed a score to assess effects of multimorbidity on difficult-to-treat asthma, the MiDAS score.4 From their conclusion, this score could help clinicians to identify patients most at risk to suffer from their multimorbidity.
Barbara Fuchs
Medical Lead, Chiesi Nordic
References:
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- Kurukulaaratchy RJ, Freeman A, Bansal AT, Kadalayil L, Denton E, Clark V, Gibson PG, Varkonyi-Sepp J, Ainsworth B, Hudson-Colby JJ, Lewis A, Eames C, Wei L, Fong WCG, Djukanovic R, Hromis S, Tay TR, Lugogo N, McDonald VM, Hew M, Haitchi HM. 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 Sep;13(9):821-832. doi: 10.1016/S2213-2600(25)00135-3. Epub 2025 Jul 8. PMID: 40645203.
ID 22694-16.06.2026