Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
Eur Respir Rev. 2023 Mar 8;32(167). doi: 10.1183/16000617.0202-2022. Print 2023 Mar 31.
The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma.
A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations Cohen's method. Cohen's 0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657.
Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test.
This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.
既往研究从未根据非哮喘人群中合并症的患病率对合并症与哮喘之间的关联强度进行排序。本研究旨在探讨合并症与哮喘之间的关联强度。
我们对报告哮喘和非哮喘人群中合并症数据的观察性研究进行了全面的文献检索。进行了成对的荟萃分析，并通过将比值比和 95%置信区间与非哮喘人群中合并症的发生率进行锚定（Cohen's 方法）来计算关联强度。Cohen's 0.2、0.5 和 0.8 分别为小、中和大效应量的截断值；效应量非常大时 Cohen's >0.8。本研究已在 PROSPERO 数据库中注册，注册号为 CRD42022295657。
共纳入了 5493776 名受试者的数据进行分析。过敏性鼻炎（OR 4.24，95%CI 3.82-4.71）、过敏性结膜炎（OR 2.63，95%CI 2.22-3.11）、支气管扩张症（OR 4.89，95%CI 4.48-5.34）、高血压性心肌病（OR 4.24，95%CI 2.06-8.90）和鼻塞（OR 3.30，95%CI 2.96-3.67）与哮喘显著相关（Cohen's >0.5 且≤0.8）；慢性阻塞性肺疾病（OR 6.23，95%CI 4.43-8.77）和其他慢性呼吸道疾病（OR 12.85，95%CI 10.14-16.29）与哮喘的相关性非常强（Cohen's >0.8）。在严重哮喘患者中，合并症与哮喘的相关性更强。根据漏斗图和 Egger 检验，未发现偏倚。
本荟萃分析支持采用个体化疾病管理策略的重要性，该策略不应仅局限于哮喘本身。应采用多维方法评估症状控制不佳是否与未控制的哮喘或未控制的潜在合并症有关。
