A large pan‑European observational study has identified distinct and reproducible multimorbidity phenotypes in patients with severe asthma, offering new insight into why outcomes vary widely among individuals with the condition and highlighting the need for more holistic, personalized care.
In the paper, “Multimorbidity Phenotypes and Associated Characteristics in Severe Asthma: An Observational Study of European Severe Asthma Registries,” researchers analyzed cross‑sectional data from 2,690 patients with severe asthma across 11 European countries, using information from the Severe Heterogeneous Asthma Research Collaboration: Patient‑Centered (SHARP) registry. They examined patterns of co‑existing conditions to better understand how comorbidities cluster and influence disease severity and outcomes. The paper was published in The Lancet Regional Health Europe.
Despite regional differences in health care systems and patient characteristics, researchers identified three comorbidity clusters that appeared consistently across Northern, Southern, Eastern and Western Europe:
- Osteoporosis with steroid‑induced weight gain
- Eczema with rhinitis
- Chronic sinusitis with nasal polyps
According to the paper, additional conditions — including obesity, bronchiectasis, gastroesophageal reflux disease and psychological disorders — showed more variable clustering depending on geographic region.
Using these clusters, researchers categorized patients into several multimorbidity phenotypes (MMPs) with distinct clinical characteristics. The most common were a sinonasal‑associated phenotype and an unclustered phenotype. However, researchers noted that the most severe outcomes appeared in steroid‑associated and maximal multimorbidity phenotypes, which were linked to higher oral corticosteroid use, poorer lung function, worse asthma control and more frequent exacerbations.
Conversely, the authors noted that patients with sinonasal‑associated multimorbidity tended to have better asthma control, preserved lung function and stronger type 2 inflammatory traits, suggesting they may respond more favorably to existing biologic therapies.
The findings demonstrate that multimorbidity is nearly universal in severe asthma and that specific patterns of comorbidities are associated with markedly different outcomes, said the researchers, who argued that current asthma management strategies — which often focus primarily on airway inflammation — may overlook critical drivers of poor health in many patients.
By identifying stable and clinically meaningful multimorbidity phenotypes, the study’s authors said the results support a shift toward whole‑patient, precision‑based management that addresses both asthma and its accompanying conditions. The authors noted that reducing reliance on long‑term oral corticosteroids and earlier use of targeted biologic therapies may help prevent some of the most severe multimorbidity profiles.
Incorporating multimorbidity phenotyping into routine severe asthma care could improve patient outcomes, optimize resource use and inform future clinical guidelines across Europe, researchers concluded.
