Evidence map›Paper›PMID 41694692›Full record

ArticleThe Lancet regional health. Europe2026

Multimorbidity phenotypes and associated characteristics in severe asthma: an observational study of European severe asthma registries.

Anna Freeman, Saša Rink, Aruna T Bansal, Betty Frankemölle, Mehar Singh, Jacob K Sont, Apostolos Bossios, Ben Ainsworth, Michael Hyland, Rekha Chaudhuri and 50 more

Abstract read
In one paragraph

Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Asthma and Multimorbidity Amongst Ethnic Minority Groups in High Income Countries.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026
    Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

60 authors.

Anna FreemanSchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Saša RinkDepartment of Pulmonary Diseases and Allergy, University Medical Centre Ljubljana, Slovenia.
Aruna T BansalAcclarogen Ltd, St John's Innovation Centre, Cambridge, UK.
Betty FrankemölleEuropean Lung Foundation, UK.
Mehar SinghEuropean Lung Foundation, UK.
Jacob K SontDept of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
Apostolos BossiosKarolinska Severe Asthma Centre, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
Ben AinsworthSchool of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Michael HylandSchool of Psychology, University of Plymouth, Plymouth, UK.
Rekha ChaudhuriSchool of Infection and Immunity, University of Glasgow, Scotland.
Dace MatisaRiga East University Hospital, Latvia.
Florin MihaltanNațional Institute of Pneumology, Bucharest, Romania.
Antonio SpanevelloDepartment of Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
Enrico HefflerPersonalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
Ian AdcockNational Heart & Lung Institute, Imperial College London, UK.
Martina ZappaDepartment of Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
Giorgio Walter CanonicaDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
Guy BrusselleDepartment of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
Arnaud BourdinDepartment of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France.
Giulia Anna Maria Luigia CostanzoDepartment of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
Ildiko HorvathNational Koranyi Institute of Pulmonology, Budapest, Hungary.
Dóra LúðvíksdóttirDepartment of Respiratory Medicine, Landspitali University Hospital and University of Iceland, Iceland.
Stefania PrincipeAmsterdam University Medical Centre, the Netherlands.
Peter KopačUniversity Clinic of Respiratory Diseases Golnik, Slovenia.
Cláudia Chaves LoureiroPneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Salman SiddiquiNational Heart & Lung Institute, Imperial College London, UK.
Arne EgestenDepartment of Clinical Sciences Lund, Respiratory Medicine, Allergology, & Palliative Medicine, Lund University and Skåne University Hospital, Lund, Sweden.
Virginija Kalinauskaite-ZukauskeDepartment of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Sanja Dimic-JanjicFaculty of Medicine, University of Belgrade, Belgrade, Serbia.
Graham RobertsSchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Sanja HromisInstitute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Branislava MilenkovicClinic for Pulmonary Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.
Judit Varkonyi-SeppSchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Ozlem GokselDepartment of Pulmonary Diseases, Ege University Faculty of Medicine, İzmir, Türkiye.
Ana M PereiraMEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Ratko DjukanovicNational Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Angela RizziUOSD Allergologia e Immunologia Clinica. Dipartimento Scienze Mediche e Chirurgiche. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Marco CaminatiDepartment of Medicine, University of Verona, Verona, Italy.
Ruihua HouSchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Anamarija ŠtajduharClinic for pulmonary diseases Jordanovac, University Hospital Centre Zagreb, Croatia.
Dóra ParóczaiDepartment of Pulmonology, University of Szeged, Hungary.
Luisa BrussinoAllergy and Immunology unit, Department of medical sciences, University of Turin, Italy.
Liam HeaneyWellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, UK.
Hans Michael HaitchiSchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Matteo BoniniDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
Kristina BieksieneDepartment of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Ebru DamadogluDepartment of Pulmonology, Division of Allergy and Clinical Immunology, Hacettepe University, School of Medicine, Ankara, Türkiye.
Valentyna YasinskaKarolinska Severe Asthma Centre, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
Bilun GemiciogluDepartment of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye.
Sanja Popović GrleClinic for pulmonary diseases Jordanovac, University Hospital Centre Zagreb, Croatia.
Anneke Ten BrinkeDepartment of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
Zsuzsanna CsomaNational Koranyi Institute of Pulmonology, Budapest, Hungary.
Iveta KroicaRiga East University Hospital, Latvia.
Piotr KunaMedical University of Lodz, Poland.
Barbro DahlenClinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Celeste PorsbjergDepartment of Respiratory and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark.
Hilary HodgeEuropean Lung Foundation, UK.
Sabina ŠkrgatDepartment of Pulmonary Diseases and Allergy, University Medical Centre Ljubljana, Slovenia.
Florence SchleichLab of Exercise Physiology, University of Liege, Belgium.
Ramesh J KurukulaaratchySchool of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The phenotypic nature of multimorbidity in severe asthma is poorly understood. Our aims in this study were to define multimorbidity phenotypes and their characteristics in severe asthma across Europe by identifying and characterising co-aggregation of comorbidities. Methods: Cross-sectional patient data were analysed from the pan-European Severe Heterogenous Asthma Research Collaboration: Patient Centred (SHARP) Central database of national severe asthma registries. Patients were grouped by four European regions (North, South, East, and West). Hierarchical clustering of comorbidities was applied to characterise the correlation structure of the ten commonest comorbidities within these geographical regions. Subsequent multimorbidity phenotypes (MMP) and their clinical features were then defined. Findings: Data were available for 2690 severe asthma patients and 23 comorbidities from 11 countries. Three comorbidity clusters were consistently seen across the four European regions: 1) osteoporosis plus steroid-induced weight gain, 2) eczema plus rhinitis, and 3) chronic sinusitis plus nasal polyps. Four further comorbidities (obesity, bronchiectasis, gastro-oesophageal reflux disease, psychological factors) showed variable clustering. Multimorbidity was ubiquitous. Patients were assigned multimorbidity phenotypes (MMP) according to comorbidity cluster alignment. MMP sn (sinonasal-associated) and MMP u (no specific cluster alignment) were commonest. MMP ster (steroid-associated multimorbidity) had highest maintenance oral steroid (m-OCS) use, and Body Mass Index, plus worst lung function, asthma control, and asthma exacerbation frequency. MMP max (maximal multimorbidity) showed high prevalence of variably assigned comorbidities, higher m-OCS and biologic treatment needs. Interpretation: Multimorbidity is common in severe asthma and can be classified into replicable novel phenotypes with characteristic clinical traits and outcomes. Recognising these phenotypes can guide better care of the 'whole patient' with severe asthma. Future clinical guidance should promote such understanding in order to support delivery of more effective personalised asthma care. Funding: European Respiratory Society, pharmaceutical industry partners (Sanofi, TEVA, Novartis, GlaxoSmithKline, Chiesi).

Indexed as

ClusterMultimorbidityPhenotypeSevere asthma

Identifiers

PMID41694692
PMCPMC12906202

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