Treatable traits in asthma associated with hospitalisations

Personalised medicine targets treatable traits with tailored therapy. Extrapulmonary traits, modifiable and related to asthma, were analysed for their association with hospitalisation rates.

We conducted an observational study of a general population cohort in Sweden, based on the Respiratory Health in Northern Europe (RHINE) and Global Allergy and Asthma European Network (GA²LEN) studies. Participants completed questionnaires in 2008-2010, including respiratory symptoms, smoking habits and education level. Data were linked with national health registers to obtain information on hospitalisations with asthma.

Of 31 000 participants, 2341 had current asthma. Asthma patients exhibited a higher prevalence of airway comorbidities, such as rhinitis, allergic rhinitis and chronic rhinosinusitis, which were associated with increased hospitalisation rates. Obesity, insomnia and snoring were also significant risk factors for hospitalisation. A clear trend of increasing hospitalisations was observed with a higher number of treatable traits, especially in asthma patients aged <60 years, who had significantly increased odds of hospitalisation when presenting with three or more traits (adjusted OR 1.88, 95% CI 1.03-3.42). Chronic rhinosinusitis contributed the most to hospitalisations (10.7% population attributable fraction), followed by obesity (8.6% population attributable fraction). On average, each increase in number of treatable traits was associated with a 13% increased risk of hospitalisation (HR 1.13, 95% CI 1.02-1.25, p=0.02). Smoking and damp/mould exposure had a negligible contribution to the overall burden of hospitalisations with asthma.

Recognising extrapulmonary traits like obesity and chronic rhinosinusitis is vital in asthma management, as they increase the risk of future hospitalisations.