Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

Ghislaine Scelo; Carlos A. Torres-Duque; Jorge Maspero; Trung N. Tran; Ruth Murray; Neil Martin; Andrew N. Menzies-Gow; Mark Hew; Matthew J. Peters; Peter G. Gibson; George C. Christoff; Todor A. Popov; Andréanne Côté; Celine Bergeron; Delbert Dorscheid; J. Mark FitzGerald; Kenneth R. Chapman; Louis Philippe Boulet; Mohit Bhutani; Mohsen Sadatsafavi; Libardo Jiménez-Maldonado; Mauricio Duran-Silva; Bellanid Rodriguez; Carlos Andres Celis-Preciado; Diana Jimena Cano-Rosales; Ivan Solarte; Maria Jose Fernandez-Sanchez; Patricia Parada-Tovar; Anna von Bülow; Anne Sofie Bjerrum; Charlotte S. Ulrik; Karin Dahl Assing; Linda Makowska Rasmussen; Susanne Hansen; Alan Altraja; Arnaud Bourdin; Camille Taille; Jeremy Charriot; Nicolas Roche; Andriana I. Papaioannou; Konstantinos Kostikas; Nikolaos G. Papadopoulos; Sundeep Salvi; Deirdre Long; Patrick D. Mitchell; Richard Costello; Concetta Sirena; Cristina Cardini; Enrico Heffler; Francesca Puggioni; Giorgio Walter Canonica; Giuseppe Guida; Takashi Iwanaga; Mona Al-Ahmad; Désirée Larenas Linnemann; Ulises Garcia; Piotr Kuna; João A. Fonseca; Riyad Al-Lehebi; Mariko Siyue Koh; Chin Kook Rhee; Borja G. Cosio; Luis Perez de Llano; Diahn Warng Perng (Steve); Erick Wan Chun Huang; Hao Chien Wang; Ming Ju Tsai; Bassam Mahboub; Laila Ibraheem Jaber Salameh; David Jackson; John Busby; Liam G. Heaney; Paul Pfeffer; Amanda Grippen Goddard; Eileen Wang; Flavia Hoyte; Michael E. Wechsler; Nicholas Chapman; Rohit Katial; Victoria Carter; Lakmini Bulathsinhala; Neva Eleangovan; Con Ariti; Juntao Lyu; David B. Price; Celeste Porsbjerg

doi:10.1016/j.anai.2023.08.021

Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

Ghislaine Scelo, Carlos A. Torres-Duque, Jorge Maspero, Trung N. Tran, Ruth Murray, Neil Martin, Andrew N. Menzies-Gow, Mark Hew, Matthew J. Peters, Peter G. Gibson, George C. Christoff, Todor A. Popov, Andréanne Côté, Celine Bergeron, Delbert Dorscheid, J. Mark FitzGerald, Kenneth R. Chapman, Louis Philippe Boulet, Mohit Bhutani, Mohsen SadatsafaviLibardo Jiménez-Maldonado, Mauricio Duran-Silva, Bellanid Rodriguez, Carlos Andres Celis-Preciado, Diana Jimena Cano-Rosales, Ivan Solarte, Maria Jose Fernandez-Sanchez, Patricia Parada-Tovar, Anna von Bülow, Anne Sofie Bjerrum, Charlotte S. Ulrik, Karin Dahl Assing, Linda Makowska Rasmussen, Susanne Hansen, Alan Altraja, Arnaud Bourdin, Camille Taille, Jeremy Charriot, Nicolas Roche, Andriana I. Papaioannou, Konstantinos Kostikas, Nikolaos G. Papadopoulos, Sundeep Salvi, Deirdre Long, Patrick D. Mitchell, Richard Costello, Concetta Sirena, Cristina Cardini, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica, Giuseppe Guida, Takashi Iwanaga, Mona Al-Ahmad, Désirée Larenas Linnemann, Ulises Garcia, Piotr Kuna, João A. Fonseca, Riyad Al-Lehebi, Mariko Siyue Koh, Chin Kook Rhee, Borja G. Cosio, Luis Perez de Llano, Diahn Warng Perng (Steve), Erick Wan Chun Huang, Hao Chien Wang, Ming Ju Tsai, Bassam Mahboub, Laila Ibraheem Jaber Salameh, David Jackson, John Busby, Liam G. Heaney, Paul Pfeffer, Amanda Grippen Goddard, Eileen Wang, Flavia Hoyte, Michael E. Wechsler, Nicholas Chapman, Rohit Katial, Victoria Carter, Lakmini Bulathsinhala, Neva Eleangovan, Con Ariti, Juntao Lyu, David B. Price, Celeste Porsbjerg

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).

Original language	English
Pages (from-to)	42-53
Number of pages	12
Journal	Annals of Allergy, Asthma and Immunology
Volume	132
Issue number	1
DOIs	https://doi.org/10.1016/j.anai.2023.08.021
Publication status	Published - Jan 2024

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Scelo, G., Torres-Duque, C. A., Maspero, J., Tran, T. N., Murray, R., Martin, N., Menzies-Gow, A. N., Hew, M., Peters, M. J., Gibson, P. G., Christoff, G. C., Popov, T. A., Côté, A., Bergeron, C., Dorscheid, D., FitzGerald, J. M., Chapman, K. R., Boulet, L. P., Bhutani, M., ... Porsbjerg, C. (2024). Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry. Annals of Allergy, Asthma and Immunology, 132(1), 42-53. https://doi.org/10.1016/j.anai.2023.08.021

@article{cb4b88754c774abb820d0815f828d441,

title = "Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry",

abstract = "Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).",

author = "Ghislaine Scelo and Torres-Duque, {Carlos A.} and Jorge Maspero and Tran, {Trung N.} and Ruth Murray and Neil Martin and Menzies-Gow, {Andrew N.} and Mark Hew and Peters, {Matthew J.} and Gibson, {Peter G.} and Christoff, {George C.} and Popov, {Todor A.} and Andr{\'e}anne C{\^o}t{\'e} and Celine Bergeron and Delbert Dorscheid and FitzGerald, {J. Mark} and Chapman, {Kenneth R.} and Boulet, {Louis Philippe} and Mohit Bhutani and Mohsen Sadatsafavi and Libardo Jim{\'e}nez-Maldonado and Mauricio Duran-Silva and Bellanid Rodriguez and Celis-Preciado, {Carlos Andres} and Cano-Rosales, {Diana Jimena} and Ivan Solarte and Fernandez-Sanchez, {Maria Jose} and Patricia Parada-Tovar and {von B{\"u}low}, Anna and Bjerrum, {Anne Sofie} and Ulrik, {Charlotte S.} and Assing, {Karin Dahl} and Rasmussen, {Linda Makowska} and Susanne Hansen and Alan Altraja and Arnaud Bourdin and Camille Taille and Jeremy Charriot and Nicolas Roche and Papaioannou, {Andriana I.} and Konstantinos Kostikas and Papadopoulos, {Nikolaos G.} and Sundeep Salvi and Deirdre Long and Mitchell, {Patrick D.} and Richard Costello and Concetta Sirena and Cristina Cardini and Enrico Heffler and Francesca Puggioni and Canonica, {Giorgio Walter} and Giuseppe Guida and Takashi Iwanaga and Mona Al-Ahmad and Linnemann, {D{\'e}sir{\'e}e Larenas} and Ulises Garcia and Piotr Kuna and Fonseca, {Jo{\~a}o A.} and Riyad Al-Lehebi and Koh, {Mariko Siyue} and Rhee, {Chin Kook} and Cosio, {Borja G.} and {de Llano}, {Luis Perez} and {Perng (Steve)}, {Diahn Warng} and Huang, {Erick Wan Chun} and Wang, {Hao Chien} and Tsai, {Ming Ju} and Bassam Mahboub and Salameh, {Laila Ibraheem Jaber} and David Jackson and John Busby and Heaney, {Liam G.} and Paul Pfeffer and Goddard, {Amanda Grippen} and Eileen Wang and Flavia Hoyte and Wechsler, {Michael E.} and Nicholas Chapman and Rohit Katial and Victoria Carter and Lakmini Bulathsinhala and Neva Eleangovan and Con Ariti and Juntao Lyu and Price, {David B.} and Celeste Porsbjerg",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = jan,

doi = "10.1016/j.anai.2023.08.021",

language = "English",

volume = "132",

pages = "42--53",

journal = "Annals of Allergy, Asthma and Immunology",

issn = "1081-1206",

publisher = "Elsevier",

number = "1",

}

Scelo, G, Torres-Duque, CA, Maspero, J, Tran, TN, Murray, R, Martin, N, Menzies-Gow, AN, Hew, M, Peters, MJ, Gibson, PG, Christoff, GC, Popov, TA, Côté, A, Bergeron, C, Dorscheid, D, FitzGerald, JM, Chapman, KR, Boulet, LP, Bhutani, M, Sadatsafavi, M, Jiménez-Maldonado, L, Duran-Silva, M, Rodriguez, B, Celis-Preciado, CA, Cano-Rosales, DJ, Solarte, I, Fernandez-Sanchez, MJ, Parada-Tovar, P, von Bülow, A, Bjerrum, AS, Ulrik, CS, Assing, KD, Rasmussen, LM, Hansen, S, Altraja, A, Bourdin, A, Taille, C, Charriot, J, Roche, N, Papaioannou, AI, Kostikas, K, Papadopoulos, NG, Salvi, S, Long, D, Mitchell, PD, Costello, R, Sirena, C, Cardini, C, Heffler, E, Puggioni, F, Canonica, GW, Guida, G, Iwanaga, T, Al-Ahmad, M, Linnemann, DL, Garcia, U, Kuna, P, Fonseca, JA, Al-Lehebi, R, Koh, MS, Rhee, CK, Cosio, BG, de Llano, LP, Perng (Steve), DW, Huang, EWC, Wang, HC, Tsai, MJ, Mahboub, B, Salameh, LIJ, Jackson, D, Busby, J, Heaney, LG, Pfeffer, P, Goddard, AG, Wang, E, Hoyte, F, Wechsler, ME, Chapman, N, Katial, R, Carter, V, Bulathsinhala, L, Eleangovan, N, Ariti, C, Lyu, J, Price, DB & Porsbjerg, C 2024, 'Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry', Annals of Allergy, Asthma and Immunology, vol. 132, no. 1, pp. 42-53. https://doi.org/10.1016/j.anai.2023.08.021

TY - JOUR

T1 - Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

AU - Scelo, Ghislaine

AU - Torres-Duque, Carlos A.

AU - Maspero, Jorge

AU - Tran, Trung N.

AU - Murray, Ruth

AU - Martin, Neil

AU - Menzies-Gow, Andrew N.

AU - Hew, Mark

AU - Peters, Matthew J.

AU - Gibson, Peter G.

AU - Christoff, George C.

AU - Popov, Todor A.

AU - Côté, Andréanne

AU - Bergeron, Celine

AU - Dorscheid, Delbert

AU - FitzGerald, J. Mark

AU - Chapman, Kenneth R.

AU - Boulet, Louis Philippe

AU - Bhutani, Mohit

AU - Sadatsafavi, Mohsen

AU - Jiménez-Maldonado, Libardo

AU - Duran-Silva, Mauricio

AU - Rodriguez, Bellanid

AU - Celis-Preciado, Carlos Andres

AU - Cano-Rosales, Diana Jimena

AU - Solarte, Ivan

AU - Fernandez-Sanchez, Maria Jose

AU - Parada-Tovar, Patricia

AU - von Bülow, Anna

AU - Bjerrum, Anne Sofie

AU - Ulrik, Charlotte S.

AU - Assing, Karin Dahl

AU - Rasmussen, Linda Makowska

AU - Hansen, Susanne

AU - Altraja, Alan

AU - Bourdin, Arnaud

AU - Taille, Camille

AU - Charriot, Jeremy

AU - Roche, Nicolas

AU - Papaioannou, Andriana I.

AU - Kostikas, Konstantinos

AU - Papadopoulos, Nikolaos G.

AU - Salvi, Sundeep

AU - Long, Deirdre

AU - Mitchell, Patrick D.

AU - Costello, Richard

AU - Sirena, Concetta

AU - Cardini, Cristina

AU - Heffler, Enrico

AU - Puggioni, Francesca

AU - Canonica, Giorgio Walter

AU - Guida, Giuseppe

AU - Iwanaga, Takashi

AU - Al-Ahmad, Mona

AU - Linnemann, Désirée Larenas

AU - Garcia, Ulises

AU - Kuna, Piotr

AU - Fonseca, João A.

AU - Al-Lehebi, Riyad

AU - Koh, Mariko Siyue

AU - Rhee, Chin Kook

AU - Cosio, Borja G.

AU - de Llano, Luis Perez

AU - Perng (Steve), Diahn Warng

AU - Huang, Erick Wan Chun

AU - Wang, Hao Chien

AU - Tsai, Ming Ju

AU - Mahboub, Bassam

AU - Salameh, Laila Ibraheem Jaber

AU - Jackson, David

AU - Busby, John

AU - Heaney, Liam G.

AU - Pfeffer, Paul

AU - Goddard, Amanda Grippen

AU - Wang, Eileen

AU - Hoyte, Flavia

AU - Wechsler, Michael E.

AU - Chapman, Nicholas

AU - Katial, Rohit

AU - Carter, Victoria

AU - Bulathsinhala, Lakmini

AU - Eleangovan, Neva

AU - Ariti, Con

AU - Lyu, Juntao

AU - Price, David B.

AU - Porsbjerg, Celeste

PY - 2024/1

Y1 - 2024/1

N2 - Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).

AB - Background: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. Objective: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. Methods: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). Results: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. Conclusion: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial Registration: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).

UR - http://www.scopus.com/inward/record.url?scp=85174415775&partnerID=8YFLogxK

U2 - 10.1016/j.anai.2023.08.021

DO - 10.1016/j.anai.2023.08.021

M3 - Article

C2 - 37640263

AN - SCOPUS:85174415775

SN - 1081-1206

VL - 132

SP - 42

EP - 53

JO - Annals of Allergy, Asthma and Immunology

JF - Annals of Allergy, Asthma and Immunology

IS - 1

ER -

Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

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