Severe asthma study discovers hidden clusters of long-term health conditions

Researchers have identified recurring patterns of additional illness in people with severe asthma, including steroid-related osteoporosis and weight gain, severe allergic disease and chronic sinusitis with nasal polyps

Most people who live with severe asthma also have additional long-term health conditions that may not always receive sufficient clinical attention, according to a major study of patients across Europe.

Researchers analysed data from 2,700 people with severe asthma in 11 European countries and found that comorbidities, including obesity, osteoporosis, allergic disease, chronic sinusitis and nasal polyps, tended to appear in recurring clusters. The findings have suggested that to identify these patterns could help clinicians to tailor care more effectively for patients with the most difficult-to-control forms of asthma.

The study was led by researchers from the University of Southampton, University Hospital Southampton and the National Institute for Health and Care Research Southampton Biomedical Research Centre, all in the UK. The work was undertaken with SHARP -- the Severe Heterogeneous Asthma Research collaboration: Patient centred – a European Respiratory Society clinical research collaboration.

The researchers said the study provided the first detailed description of how long-term health conditions commonly occur together in patients with severe asthma. Severe asthma can require high-intensity treatment and may continue to cause symptoms, exacerbations and impaired quality of life despite standard therapies. In such patients, additional conditions can complicate diagnosis, influence treatment choice and worsen outcomes.

Study lead author Professor Ramesh Kurukulaaratchy, professor in respiratory medicine and allergy at the University of Southampton, said the results showed that nearly all patients in the study had at least one other major health issue, while most had three or more. Professor Kurukulaaratchy is also an honorary consultant at University Hospital Southampton.

“The patterns we found were linked to how well asthma was controlled, how often attacks happened and the treatments needed.

“Better understanding these patterns will help us look beyond asthma alone and improve the care for people living with severe asthma,” Kurukulaaratchy said.

Although asthma affects patients in different ways, the researchers identified three distinct clinical profiles that appeared consistently across the study population:

• • One group was characterised by high steroid use, with patients to report high rates of osteoporosis and treatment-associated weight gain.
  • A second profile involved severe allergic disease, including eczema alongside hay fever, also known as rhinitis.
  • A third profile was linked to chronic sinusitis and nasal polyps, conditions that can contribute to persistent airway inflammation and may make asthma harder to control.

The findings are likely to be important because severe asthma management has increasingly moved beyond a single-disease model. For patients who experience repeated attacks, persistent symptoms or dependence on oral corticosteroids, clinicians may need to assess the wider burden of disease and not simply escalate asthma medication. The study has indicated that comorbidity patterns may help to explain why some patients respond poorly to treatment and why some require more intensive clinical support.

“People with severe asthma often live with a heavy burden of other conditions but, until now, we didn’t fully understand how they were linked,” Dr Anna Freeman, joint first author and respiratory consultant at University Hospital Southampton, said.

“With our results, we can improve the quality of life for millions of people across Europe who currently struggle to keep their severe asthma under control,” she added.

The researchers said to recognise these clusters could support more personalised care, including earlier identification of steroid-related complications, more targeted treatment for allergic disease and improved assessment of upper-airway conditions such as sinusitis and nasal polyps. For patients, the findings underline the need for severe asthma care to consider the full clinical picture rather than to treat asthma symptoms in isolation.

For further reading please visit: 10.1016/j.lanepe.2026.101600