Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome

Judit Varkonyi-Sepp, Anna Freeman, Ben Ainsworth, Latha Perunthadambil Kadalayil, Hans Michael Haitchi, Ramesh J. Kurukulaaratchy

Research output: Contribution to journalReview articlepeer-review

6 Citations (SciVal)


Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially “treatable traits” that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a “Difficult Breathing Syndrome” that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.

Original languageEnglish
Article number1435
JournalJournal of Personalized Medicine
Issue number9
Early online date30 Sept 2022
Publication statusPublished - 30 Sept 2022


  • asthma
  • co-morbidity
  • difficult breathing syndrome
  • holistic treatment
  • multimorbidity
  • non-pharmacological
  • personalized
  • therapy
  • treatable traits
  • treatment

ASJC Scopus subject areas

  • Medicine (miscellaneous)


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