Table 2.

Co-morbidities in severe asthma: diagnosis and management.

Co-morbidity	Prevalence	Test	Management
Rhinosinusitis/Nasal polyps	50% [61]	SNOT-22 questionaire CT of sinuses Nasendoscopy (ENT assessment)	Nasal lavage Nasal steroid spray/drops Surgery
Allergic Rhinoconjuctivitis (*Positive skin prick test to aeroallergens)	70% [61]*	History + skin prick test/specific IgE	Nasal steroids Antihistamines Montelukast
COPD	20% [171]	History incl smoking DLCO/HRCT (emphysema)	Add LAMA Add Roflumilast Rehabilitation
Dysfunctional Breathing	19–52 [59,172]%	History/Nijmegen questionaire	Physioterapy – breathing retraining
VCD	32–50% [59,74]-	Laryngoscopy	Speech therapist
Anxiety/Depression	4–17% [9,17]	HADS questionnaire Psychiatric assessment Psychiatrist	Medical treatment Psychotherapy
OSAS	31% [80]	Screening with STOP-BANG Polysomnography/respiratory polygraphy	Weight loss CPAP
Obesity	37% [18]	BMI	Dietician
Gastro-esophageal Reflux	17–74% [18,22,61,173]	3 months of empiric PPI 24-hours pH monitoring	PPI Lifestyle interventions
Bronchiectasis	25–40% [91,92]	HRCT	Physiotherapy, inhalation of hyperosmolar agents, low-dose macrolides
ABPA	1–2% [96]	Total IgE, IgE and IgG to aspergillus fumigatus, B-eosinophils, HRCT	Prednisolone. Anti-fungal treatment.

OSAS: Obstructive Sleep Apnea Syndrome.

VCD: Vocal Chord Dysfunction.

ABPA: Allergic Bronchopulmonary Aspergillosis.