The contribution of comorbidities, psychosocial factors and adherence to the presentation of severe asthma

Asthma control may remain elusive for reasons apart from severe asthma biology. Several comorbidities which worsen asthma control, mimic poor asthma control or both, are highly prevalent in severe asthma cohorts. These comorbidities impact breathing perception and control the upper airway (nasal and sinus cavities), the middle airway (oropharynx and larynx), and the lower airway (including the tracheobronchial tree). The detection and management of these comorbidities is, therefore, a key aspect of severe asthma management. At the same time, asthma control may also be impacted by social, psychological and behavioural factors. These factors may impede access to, and engagement with, healthcare services, prevent effective asthma self-management, or interfere with the effectiveness of pharmacological and non-pharmacological therapies. Chief among these is poor adherence to prescribed medication, with significant challenges in both detecting and managing the issue. Clinicians who seek to manage severe asthma patients should develop and employ a consistent, comprehensive, multidisciplinary approach to these comorbidities and psychosocial factors (including adherence) ideally delivered by a dedicated severe asthma service. Such a systematic approach is associated with improved patient outcomes.