Comorbidity Burden and Clinical Management Challenges in Severe Asthma: Insights from a Pan-European SHARP Study

Severe asthma (SA) is commonly complicated by multiple comorbidities, which significantly worsen clinical outcomes. However, the recognition of asthma comorbidities in clinical practice remains unclear. We aimed to assess gaps in comorbidity documentation in SA registries, evaluate comorbidity prevalence and variation across Europe, and explore physician perspectives on multimorbidity management, with a focus on real-world recognition and documentation of comorbidities.

We analysed data from 13,245 SA patients across 22 European registries. Thirty-two clinically relevant comorbidities were grouped into five categories (type 2 (T2)-related, pulmonary, extrapulmonary, psychophysiological, and steroid-related) to assess registry capture and national prevalence. A pan-European online survey of 239 SA specialists explored clinical approaches and resources for multimorbidity management.

Across the registries, T2-related and pulmonary comorbidities were captured more consistently than extrapulmonary, psychophysiological, and steroid-related conditions, with substantial variation between countries. The most prevalent recorded comorbidities included chronic sinusitis (40%), nasal polyps (35%), obesity (30%), allergic rhinitis (30%), and gastroesophageal reflux disease (29%) but their prevalence varied widely across countries. Forty-one percent of surveyed physicians lacked multidisciplinary team (MDT) access, with lack of time (36%) and funding (26%) reported as the main barriers. Eighty-five percent of respondents acknowledged the impact of multimorbidity on asthma outcomes and expressed a need for improved training and patient education to improve its management.

Comorbidities are highly prevalent in European SA populations but remain inconsistently documented across registries, especially steroid-related conditions. However, these findings should be interpreted in the context of heterogeneity in registry structure, diagnostic pathways, and data capture practices across countries. Limited resources further constrain optimal multimorbidity management. These findings highlight the need for standardized registry protocols, improved MDT access, and targeted education. This study provides the first pan-European evaluation of comorbidity capture in SA registries alongside physician perspectives on multimorbidity.