A multifaceted clinical phenomenon: the CORE syndrome

<bold>Background:</bold> Asthma, obstructive sleep apnea (OSA), rhinosinusitis, and esophageal reflux are conditions that may coincide, forming a syndrome known as CORE. If left unaddressed, this syndrome can exacerbate all associated comorbidities. <bold>Objectives:</bold> If clinical remission of severe asthma (SA) is not attained, it is essential to investigate for the presence of comorbidities, in particular the presence of OSA that may lead to the diagnosis of CORE syndrome. <bold>Methods:</bold> The study was conducted on 53 consecutive patients diagnosed with SA, referred to our institute since 2018. Despite maximal inhalation therapy and biological treatment, 10 patients presented uncontrolled AS assessed by asthma control test (ACT), as well as rhinosinusitis and esophageal reflux, underwent evaluation for OSA by cardiorespiratory polygraphy. Subsequently, patients diagnosed with CORE syndrome received comprehensive treatment for all concurrent comorbidities and were reevaluated over time. <bold>Results:</bold> 6 patients with CORE syndrome were found. Mean AHI was 33.25±20.13 events/h, oxygen desaturation index (ODI) was 28.95±19.95 events/h, time in bed with SaO2 <90% (T90) was 26.40±27.22% 1 for which positive airway pressure (PAP) device treatment was proposed but only 3 out of 6 patients accepted. After 12 months of treatment for all comorbidities all patients CPAP-treated manifested an improvement in ACT score (+8 (+32%), +9 (+36%), +14 (+56%) points), absence of exacerbations and discontinuation of oral corticosteroids (OCS) leading to clinical remission of asthma. <bold>Conclusion:</bold> A multidisciplinary approach is essential for the management of CORE patients, particularly in diagnosing and treating OSA.