Comorbidity in bronchial asthma: how significant is it, and what are the implications of treating beyond asthma alone?

Poor control of bronchial asthma is frequently attributable to a severe and biologically driven disease course, which remains a central focus of ongoing research and targeted, phenotype-specific therapy. Nevertheless, there is accumulating evidence that extrapulmonary comorbidities significantly contribute to poor asthma control and increase overall disease burden. These comorbid conditions have been proposed as "curable signs" within the spectrum of chronic respiratory disorders. This review addresses the major comorbidities associated with asthma, including rhinitis, chronic rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and obesity. The prevalence of these conditions, their impact on the asthma clinical course, and the effects of comorbidity-directed treatments within the asthmatic population are critically analyzed. The deleterious influence of comorbid pathologies on asthma symptom control, exacerbation frequency, and overall quality of life in affected patients is demonstrated. The presence of symptomatic comorbid diseases necessitates targeted management irrespective of underlying asthma status or degree of asthma control. However, robust clinical trial evidence confirming that treatment of comorbid conditions leads to improved asthma outcomes is presently available only for selected comorbidities, and even then, findings have been inconsistent. This underscores the need for further comprehensive research in this domain. KEYWORDS: asthma, comorbidity, rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obesity, obstructive sleep apnea. FOR CITATION: Karoli N.A. Comorbidity in bronchial asthma: how significant is it, and what are the implications of treating beyond asthma alone? Russian Medical Inquiry. 2025;9(2):125–132 (in Russ.). DOI: 10.32364/2587-6821-2025-9-2-5