title: Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms.
abstract: Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes.
authors.affiliation: Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; Department of Respiratory Medicine, University of Tampere, 33521 Tampere, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kankaanranta
authors.affiliation: Department of Respiratory Medicine and Allergology, Skin and Allergy Hospital, Helsinki University Hospital and Helsinki University, 00029 Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Kauppi
authors.affiliation: Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland.
authors.forename: Leena E
authors.initials: LE
authors.lastname: Tuomisto
authors.affiliation: Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland.
authors.forename: Pinja
authors.initials: P
authors.lastname: Ilmarinen
mesh_terms: D000818:Animals; D001249:Asthma / Q000209:etiology* / Q000378:metabolism*; D003863:Depression / Q000150:complications / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism; D009765:Obesity / Q000150:complications / Q000378:metabolism; D012307:Risk Factors