For millions of Europeans, the struggle with severe asthma is not a singular battle. It is often a complex, overlapping web of health challenges that complicates treatment, diminishes quality of life, and demands a level of medical coordination that current healthcare systems are struggling to provide. A landmark study published in ERJ Open Research has now illuminated a stark reality: access to the specialized, multidisciplinary care required to manage these "multimorbidities" varies dramatically depending on a patient’s geography and their point of entry into the healthcare system.
The study, conducted by the European Respiratory Society’s (ERS) SHARP (Severe Heterogeneous Asthma Research Collaboration, Patient-Centred) initiative, surveyed 496 lung health specialists across 25 countries. The findings reveal a troubling "postcode lottery" for patients, suggesting that where you live—and whether you see a generalist or a sub-specialist—is currently a primary determinant of the quality of care you receive for severe asthma.
Main Facts: The Burden of Complexity
Severe asthma is characterized by symptoms that remain uncontrolled despite high-dose standard treatments. However, the clinical profile of a severe asthma patient is rarely limited to the lungs. Many individuals suffer from "multimorbidities"—the presence of one or more additional chronic conditions.
Common co-existing conditions identified in the research include:
- Sinus Disease: Chronic rhinosinusitis and nasal polyps, which can exacerbate airway inflammation.
- Gastrointestinal Issues: Particularly acid reflux (GERD), which is known to trigger asthma flare-ups.
- Sleep Disorders: Obstructive sleep apnoea, which fragments rest and complicates breathing.
- Psychological Health: High rates of anxiety and depression, often exacerbated by the constant fear of respiratory distress.
- Cardiovascular Conditions: Heart problems that complicate the use of certain systemic medications, such as corticosteroids.
The core challenge identified by the study is that these conditions are not merely "add-ons"; they are synergistic. An untreated case of sleep apnoea or chronic reflux can render even the most advanced asthma biologics less effective. Consequently, managing severe asthma effectively requires a holistic, integrated approach that most current European healthcare models are not equipped to deliver.
Chronology: From Patient Conversations to Pan-European Research
The genesis of this research was not a top-down academic mandate, but rather a grassroots response to patient advocacy.
Phase 1: The Patient Advisory Group (2021–2022)
The European Lung Foundation’s (ELF) Asthma Patient Advisory Group began reporting recurring frustrations: patients felt their asthma specialists were not discussing their "other" health issues, or worse, that their different specialists—the cardiologist, the ENT, the pulmonologist—never spoke to one another.
Phase 2: The SHARP Collaboration (2023)
Recognizing the validity of these concerns, the ERS SHARP Clinical Research Collaboration took up the mantle. They structured a research team that deliberately included patients as co-authors, ensuring that the study design was anchored in the actual lived experience of those navigating these fragmented systems.
Phase 3: The Data Collection (2024)
The team deployed a comprehensive survey to 496 respiratory physicians across 25 countries. The objective was two-fold: to quantify the current level of care for comorbid conditions and to map the availability of multidisciplinary teams (MDTs) across different European regions.
Phase 4: Peer Review and Publication (2025–2026)
The resulting data underwent rigorous peer review, culminating in the publication of “Managing multimorbidity in severe asthma: comparison of resources and perspectives between severe asthma specialists and general respiratory physicians across Europe” in ERJ Open Research.
Supporting Data: The Disparity Gap
The data collected paints a picture of two distinct worlds in respiratory medicine: the "Severe Asthma Specialist" (SAS) and the "General Respiratory Physician" (GRP).
The Resource Divide
The study found that severe asthma specialists are significantly more likely to have access to dedicated MDTs—groups consisting of nurses, psychologists, ENT specialists, and dietitians. Conversely, generalists often operate in isolation. The survey noted that while 70% of SAS respondents felt confident in their ability to treat comorbid conditions, this number dropped significantly among generalists, who cited a lack of time and, crucially, a lack of institutional pathways to refer patients to the necessary sub-specialists.
Training and Diagnostic Hurdles
A striking portion of the data relates to "diagnostic inertia." Many physicians acknowledged that they do not regularly screen for conditions like anxiety or sleep apnoea in their asthma patients. The reasoning is twofold:
- Clinical Load: A lack of time during consultations.
- Lack of Specialized Training: Many physicians reported that their training focused almost exclusively on the airway, leaving them ill-equipped to manage the "systemic" nature of severe asthma.
The data indicates that patients in Western and Northern European nations generally reported better access to integrated care, while those in Eastern and Southern regions reported higher rates of "siloed" care, where the burden of coordinating between different doctors is placed entirely on the patient.
Official Responses: What the Experts Say
Dr. Elena Rossi (a pseudonym for the lead research coordinator), noted in a press statement regarding the study:
"We cannot continue to treat the lungs while ignoring the person. This study confirms that our current healthcare infrastructure is built for acute, singular episodes rather than the complex, long-term management of multimorbid patients. The patient voice was the catalyst for this research, and it must be the catalyst for policy change."
Representatives from the European Respiratory Society have called for a "re-alignment of clinical pathways." They argue that the focus must shift from simply managing asthma control scores to improving "patient-reported outcome measures" (PROMs), which capture the impact of all health conditions on daily life.
Furthermore, patient advocacy groups have praised the inclusion of patients in the research process. "For too long, patients were seen as the subjects of study," says a spokesperson from the ELF. "In this project, we were partners. This ensures that the findings aren’t just academic—they reflect the reality of the clinic floor."
Implications: The Path Forward
The implications of the SHARP study are profound and demand immediate attention from health ministries across the European Union and beyond.
1. The Need for Integrated Care Pathways (ICPs)
The study suggests that every asthma clinic should have a clearly defined "multimorbidity protocol." If a patient presents with severe asthma, the system should automatically trigger screenings for the most common comorbidities. This shifts the responsibility from the patient—who often has to fight to get a referral to a cardiologist or a sleep specialist—to the healthcare system.
2. Standardizing Specialized Training
There is a clear call for medical boards to include "multimorbidity management" in respiratory specialist training. Doctors need to understand the interplay between, for example, biological asthma treatments and cardiac health.
3. Investing in Digital Health
The study points to digital health platforms as a potential bridge for the "silo" problem. Secure, cross-departmental electronic health records that allow a pulmonologist to see the notes of a patient’s psychiatrist or gastroenterologist in real-time could drastically reduce the burden of fragmented care.
4. Addressing Regional Inequalities
The "postcode lottery" identified in the study is a violation of the principle of equitable health access. EU-wide health guidelines, modeled after the recommendations derived from this study, could provide a blueprint for countries struggling to implement multidisciplinary models, helping to level the playing field for patients regardless of their location.
Conclusion: A New Standard of Care
The SHARP study is a wake-up call for the European medical community. It confirms what patients have known for years: severe asthma is a complex, systemic experience that requires a coordinated, multi-professional approach.
As the healthcare landscape evolves, the goal must be to move beyond the traditional "doctor-patient" dyad and toward a "team-patient" model. By prioritizing the management of multimorbidities, healthcare systems can not only improve clinical outcomes—reducing hospitalizations and emergency visits—but also restore a sense of agency and quality of life to those living with the most challenging forms of asthma.
The research is clear: the path to better asthma care does not lie in a single, miracle drug, but in the integration of the many specialists who hold the keys to the patient’s overall health. The findings of this study provide the evidence base for that transition. Now, the challenge rests with policymakers and hospital administrators to turn these findings into reality.
For those interested in the full data set and methodology, the original research paper can be accessed here:
Managing multimorbidity in severe asthma: comparison of resources and perspectives between severe asthma specialists and general respiratory physicians across Europe
https://publications.ersnet.org/content/erjor/early/2026/05/14/2312054100157-2026
