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Breaking the Cycle (continued)
Practitioners’ Corner (continued from page 18)
moldy hay, and contaminated humidifiers; anti-neutrophilic cytoplasmic antibody-associated vasculitis; and allergic bron- chopulmonary mycosis. Bronchiectasis also is a commonly associated problem occurring in up to 1/3 or more individuals with severe asthma.
Likewise, concomitant secondary immunodeficiency can lead to increased upper and lower airway infections which ex- acerbate asthma. Therefore, when recurrent infections, par- ticularly in the upper and lower airways, are prevalent, under- lying immunodeficiencies should be ruled out by determining immunoglobulin levels and response to common vaccines.
Similarly, sleep apnea, various forms of occupational asth- ma, and obesity are all accompanying or comorbid conditions. Obesity, a common comorbid condition of multiple diseases, remains one of the major comorbid conditions of asthma to- day. So too, can endocrine diseases play a role, such as thyroid and adrenal gland abnormalities.
Asthma can be associated with a variety of psychological problems. When I was a resident, we were taught that asthma had psychiatric implications. So too did ulcerative colitis, peptic ulcer disease, and hypertension. Of course, today, we realize that psychological problems do not cause asthma. Psy- chiatric problems, just as with any other disease, can occur independent of one or the other or be secondary to a chronic disease, such as asthma.
In summary, asthma is a complex syndrome with a variety of different phenotypes and endotypes and coexisting and co- morbid conditions. As with any other chronic complicated disease, it requires a physician with a broad knowledge of medicine to appropriately diagnose and treat it. Without such an approach, patients with asthma will have poor outcomes.
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HCMA BULLETIN, Vol 70, No. 3 – Winter 2024