A clinician-driven study suggests that many people living with the most widespread chronic lung condition may, in reality, be dealing with several additional illnesses that often aren’t recognised or properly diagnosed.
Of the roughly 28 million Americans with asthma, about one in 10 will go on to experience severe symptoms that remain difficult to manage despite standard therapies, including intense coughing spells and breathlessness.
Researchers working with the European Respiratory Society reviewed the medical records of more than 2,700 people diagnosed with asthma in 11 countries, focusing on how frequently other serious conditions appeared alongside the hardest-to-treat cases.
According to their findings, published in The Lancet Regional Health, almost every patient in this severe-asthma group had at least one other major health issue. In many cases, the average patient was facing three significant medical problems at once.
The strong trend in the data prompted the team to call for what they described as a “deeper understanding of patterns” of poor health in severe asthma, noting that the underlying issues tended to cluster into three broad categories.
The clinicians believe that mapping these complicated combinations could help doctors tailor care more precisely for people whose asthma remains resistant to common treatment approaches.
One frequent pattern involved osteoporosis—where bones become weaker and more fragile—along with substantial weight gain that can be associated with steroid medication used to control asthma symptoms.
A second cluster of conditions centred on allergy and inflammation, including problems such as eczema, hay fever and rhinitis.
The third group commonly seen in the analysis included chronic sinusitis and nasal polyps—conditions that can drive persistent nasal inflammation over long periods, which may be especially challenging for those already struggling with asthma.
Ramesh Kurukulaaratchy, professor of respiratory medicine at the University of Southampton and study co-author, said: “The patterns we found were linked to how well asthma was controlled, how often attacks happened and the treatments needed.
“Better understanding these patterns will help us look beyond asthma alone and improve the care for people living with severe asthma.”
The researchers also highlighted that many participants were experiencing health problems tied to oral steroid use, including weight gain and reduced bone density.
On that basis, the team argued for a major shift in how severe asthma is approached, stating that we “need to eradicate oral steroid dependency in severe asthma management.”
Joint first author Dr Anna Freeman , Respiratory Consultant at University Hospital Southampton, said: “People with severe asthma often live with a heavy burden of other conditions but, until now, we didn’t fully understand how they were linked.
“With our results, we can improve the quality of life for millions of people across Europe who currently struggle to keep their severe asthma under control.”