Doctors have long focused on the lungs when treating asthma, but new research shows that might not be enough.
An international team, co-led by University of Newcastle Professor Vanessa McDonald, director of Hunter Medical Research Institute’s Asthma and Breathing program has developed a new tool called MiDAS that helps doctors identify the impacts of health issues that can make asthma harder to control. The tool, short for Multimorbidity in Difficult Asthma Score, provides a simple score based on the impact of other conditions patients with difficult asthma frequently experience and are known to worsen asthma symptoms.
“People with more difficult asthma often have multiple medical conditions,” Professor McDonald said. “This tool helps us understand the whole picture.”
Traditionally, asthma care has focused on treating the airways using puffers and steroids to reduce inflammation and improve breathing, but Professor McDonald said that while that approach is critical it isn’t usually enough for people with severe or hard-to-manage asthma.
“Doctors usually look at the lungs because that’s where asthma occurs,” she said. “But other conditions can make asthma worse, or even mimic its symptoms. If we don’t treat those too, we’re missing an opportunity.”
MiDAS takes into account seven common conditions that often appear alongside asthma: obesity, sleep apnoea, rhinitis (nasal inflammation), gastro-oesophageal reflux disease (GERD), NSAID exacerbated respiratory disease (such as reactions to ibuprofen), breathing pattern disorder, and bronchiectasis. By checking for these conditions, MiDAS helps clinicians better understand why someone might still feel breathless or unwell, even if they’re using their asthma medications correctly.
The study, published in The Lancet Respiratory Medicine journal, found that the more of these conditions a person had, the worse their asthma symptoms tended to be. These patients also reported lower quality of life and were more likely to experience anxiety, depression and increased inflammation in the body.
“This makes it easier to treat each person based on their unique health situation,” said Professor McDonald. “Asthma doesn’t exist in isolation, it’s often part of a bigger picture.”
For example, someone with asthma and obesity is more likely to experience severe asthma attacks. Managing their weight, alongside standard asthma treatment, can lead to better outcomes.
Sleep apnoea, if left undiagnosed, can also worsen asthma but is often overlooked.
Breathing pattern disorder, where people unconsciously overbreathe or breathe inefficiently, is commonly misdiagnosed as asthma itself.
“This condition doesn’t respond to asthma medication,” she said. “In these cases, we recommend breath retraining exercises instead.”
Professor McDonald said the MiDAS tool aims to give health professionals a clearer picture, helping them target the right treatments for the right patients.
“Often people don’t know exactly what’s causing their breathlessness,” she said. “They may just get more asthma medication, which can lead to side effects without solving the real problem.”
Other conditions such as reflux can also aggravate asthma, along with certain pain relievers.
“By spotting and treating these added issues, we have a real chance to improve someone’s asthma journey,” Professor McDonald said.
Developed in partnership with researchers from the UK, Singapore and the United States, the tool has already been tested in thousands of patients. The data shows a clear link between higher MiDAS scores and worse asthma outcomes, both in terms of physical symptoms and mental health.
Professor McDonald says MiDAS is designed to be simple for doctors to use, but powerful in what it reveals.
“It’s all about improving how people feel day to day, not just managing symptoms on paper,” she said.
