In es iga ing as hma como bidi ies:
a sys ema ic scoping e iew p o ocol
Ka im El Fe kh,
1
B igh Nwa u,
1,2
Ch is G i i hs,
3
Aziz Sheikh
1
To ci e: El Fe kh K, Nwa u B,
G i i hs C, e al. In es iga ing
as hma como bidi ies:
a sys ema ic scoping e iew
p o ocol. BMJ Open 2016;6:
e010548. doi:10.1136/
bmjopen-2015-010548
▸P epublica ion his o y and
addi ional ma e ial is
a ailable. To iew please isi
he jou nal (h p://dx.doi.o g/
10.1136/bmjopen-2015-
010548).
Recei ed 13 No embe 2015
Re ised 30 June 2016
Accep ed 11 July 2016
1
As hma UK Cen e o
Applied Resea ch, Cen e o
Medical In o ma ics, Ushe
Ins i u e o Popula ion Heal h
Sciences, The Uni e si y o
Edinbu gh, Edinbu gh, UK
2
School o Heal h Sciences,
Uni e si y o Tampe e,
Tampe e, Finland
3
As hma UK Cen e o
Applied Resea ch, Cen e o
P ima y Ca e and Public
Heal h, Bliza d Ins i u e,
Queen Ma y Uni e si y o
London, London, UK
Co espondence o
Ka im El Fe kh;
[email p o ec ed]c.uk
ABSTRACT
In oduc ion: As hma is a common long- e m
diso de wi h a numbe o ela ed como bid condi ions,
which may a ec as hma ou comes. The e is a need
o g ea e app ecia ion o unde s anding how hese
como bidi ies in e ac wi h as hma in o de o imp o e
as hma ou comes.
Objec i es: To sys ema ically iden i y and map ou
key as hma como bidi ies.
Me hods: We will sys ema ically sea ch he ollowing
elec onic da abases: MEDLINE, EMBASE, ISI Web o
Science, Cumula i e Index o Nu sing and Allied Heal h
Li e a u e (CINAHL), PsycINFO and Google Schola .
Addi ional li e a u e will be iden i ied by sea ching he
e e ence lis o iden i ied eligible s udies and by
sea ching he eposi o ies o in e na ional con e ence
p oceedings, including ISI Con e ence P oceeding
Ci a ion Index, and ZETOC (B i ish Lib a y).
Dissemina ion: The indings om his sys ema ic
scoping e iew will be epo ed a scien i ic mee ings
and published in a pee - e iewed jou nal.
BACKGROUND
As hma is ypically a li elong disease and
a ec s o e 300 million people wo ldwide.
1
I
is esponsible o conside able mo bidi y,
mo ali y and subs an ial heal hca e cos s.
12
E ec i e sel -managemen and pha maco-
he apy leading o well-con olled as hma is
he key managemen goal.
3–5
Key indica o s
o success ul as hma con ol include minimal
o no symp oms, no es ic ions on ac i i ies,
op imal pulmona y unc ion and minimal o
no side-e ec s o ea men .
3–6
Poo as hma
con ol is belie ed mainly o esul om inad-
equa e/subop imal ea men and p oblems
wi h adhe ence o ecommended ea men s.
45
An impo an conside a ion as well is he
impac o como bid diseases on as hma.
457–10
Many defini ions exis o as hma as he e is a
significan p opo ion o he e ogenei y; he
defini ion adop ed he e is a doc o -diagnosed
o pa ien - epo ed as hma e e .
The p esence o mo e han one condi ion
in a pe son is he widely sugges ed concep
o como bidi y.
11
The doc o -diagnosed dis-
eases should be linked o he In e na ional
Classifica ion o Diseases (ICD) ega dless o
hei ch onological occu ence (be o e o
a e he index condi ion: as hma). The
impo ance o como bidi ies lies no only in
hei p esence bu also in hei se e i y ha
can be used o con ey he concep o
‘bu den o disease’.
11
The Cha lson Index is
commonly used o compa e and unde s and
he complexi y o coexis ing diseases. A
numbe o condi ions (eg, alle gic hini is,
gas o-oesophageal eflux disease (GORD),
obesi y and dep ession) may occu mo e e-
quen lyinpeoplewi has hma hanin hose
wi hou as hma, leading o po en ial addi ional
di ficul ies in as hma managemen .
12 13
These
como bid condi ions may be associa ed wi h
poo as hma con ol, impai ed heal h- ela ed
quali y o li e (HRQoL) and inc eased heal h
and social ca e usage.
12–19
The sys ema ic iden-
ifica ion and mapping o hese como bid con-
di ions may lead o cus omised, a ge ed
ea men , which in u n o e s he po en ial
o subs an ially imp o e ou comes in pa ien s
wi h as hma, and he eby educe he need o
heal h and social ca e.
4121920
The e a e a numbe o in e na ional
s udies in es iga ing as hma como bidi y,
impac on as hma con ol and HRQoL, and
consequen heal hca e and socie al bu den,
bu hei esul s a y depending on he
popula ions s udied and he pa icula
como bid condi ions ha a e he ocus o
hese in es iga ions.
21–23
The e is a need
S eng hs and limi a ions o his s udy
▪To he bes o ou knowledge, his is he i s
e iew unde aken o map ou he ull spec um
o as hma como bidi y; hence, e idence gene -
a ed om he e iew will be impo an in shaping
he di ec ion o he ield.
▪The scoping e iew will be limi ed o he pas
5 yea s only, bu aimed o map he mos con-
empo aneous e idence on as hma como bidi y.
▪As a scoping e iew, o mal quali y assessmen
and isk o bias will no be unde aken on
s udies o be included in he e iew.
El Fe kh K, e al.BMJ Open 2016;6:e010548. doi:10.1136/bmjopen-2015-010548 1
Open Access P o ocol
g oup.bmj.com on Sep embe 25, 2016 - Published by h p://bmjopen.bmj.com/Downloaded om
he e o e o a sys ema ic in es iga ion in o he ange o
as hma como bidi ies. This scoping e iew aims o fill
his need and, in addi ion, iden i y impo an esea ch
gaps in unde s anding he ela ionship be ween as hma
and i s como bidi ies. I will no ocus on s udies ha
ha e looked a he associa ion be ween as hma and
o he diseases and ice e sa bu on s udies ha ha e
in es iga ed he impac o o he condi ions on as hma
ou comes.
METHODS
Eligibili y c i e ia
Types o s udies
Coho s udies, case–con ol s udies and c oss-sec ional
s udies will be eligible o inclusion. We will exclude edi-
o ials, animal s udies, e iews, andomised con olled
ials (RCTs), quasi-RCTs, case s udies and case se ies.
Pa icipan s
We a e in e es ed in s udies on pa icipan s o any age
wi h a clinical diagnosis o as hma.
Ou come
Clinical diagnosis o as hma: doc o -diagnosed as hma
e e o cu en assessed subjec i ely (pa ien epo ed)
o objec i ely (heal h/medical eco ds).
As hma and he como bidi ies o in e es
As his is only a scoping e iew, ou aim is o unco e he
a ious app oaches ha ha e been employed, including
he defini ion o as hma ha au ho s ha e employed.
The e o e, es ic ing ou sel es o a specificdefini ion o
as hma may also be es ic i e o ou objec i e o he
scoping sys ema ic e iew.
The como bidi ies ha we a e in e es ed in a e hose
ha exace ba e as hma’s managemen and p ognosis
(eg, e ec o as hma), ega dless o whe he hey
de elop be o e o a e as hma. We will also g oup
como bidi ies acco ding o he Cha lson Como bidi y
Index, a me hod o ca ego ising como bidi ies o
pa ien s based on he ICD diagnosis codes. We a e in e -
es ed in s udies on as hma como bidi ies; hese a e likely
o include, bu a e no limi ed o, alle gic diseases, ca -
dio ascula diseases, ch onic obs uc i e pulmona y
disease, au oimmune diso de s (eg, ype 1 diabe es),
me abolic diso de s (eg, ype 2 diabe es, obesi y),
eosinophilic diseases, psychological dys unc ion (anxie y,
dep ession), hype ension, ca dio ascula diseases and
GORD.
Sea ch me hods
Da abases
We will iden i y published s udies om he ollowing
da abases: MEDLINE, EMBASE, ISI Web o Science,
Cumula i e Index o Nu sing and Allied Heal h
Li e a u e (CINAHL), PsycINFO and Google Schola .
Addi ional li e a u e will be iden ified by sea ching he
e e ence lis o iden ified eligible s udies and by sea ch-
ing he eposi o ies o in e na ional con e ence p oceed-
ings, including ISI Con e ence P oceeding Ci a ion
Index, and ZETOC (B i ish Lib a y). Unpublished li e a-
u e and ongoing s udies will be iden ified by sea ching
he ollowing egis ies: ISI Con e ence P oceedings
Ci a ion Index ia Web o Knowledge.
Sea ch s a egy
A highly sensi i e sea ch s a egy has been de eloped in
each o he six da abases o cap u e he b oad li e a u e
on he opic (see online supplemen a y appendix).
Using bibliog aphic da abases and heal h-o ien ed
sea ch engines, he sea ch will encompass he main
concep o ou scoping e iew: as hma como bidi ies.
In o de o maximise he sensi i i y o ou sea ch, we
a e no only es ic ing ou o e all s a egy o opic
sea ches in li e a u e da abases bu a e also aking hese
s eps: consul ing wi h expe s in he field, looking in
clinical ials egis e s, looking in con e ence p oceed-
ings, looking in g ey li e a u e such as PhD heses, doing
o wa d and backwa d ci a ion acking, in e oga ing
he websi es o key o ganisa ions and hand-sea ching
jou nals. We will sea ch om Ma ch 2014 un il Ma ch
2016. Al hough i is well known ha esea che s ha e
been s udying as hma as a he e ogeneous disease
a ec ed by mul iple como bidi ies, howe e , he e i-
dence on as hma and como bidi ies inc eased exponen-
ially in he pas yea s. In addi ion, ou p elimina y
sea ch p o ided o e 20 000 eco ds om one da abase;
his 2-yea ime ame will enable us o achie e ou
objec i es in a p agma ic manne .
S udy selec ion
The a icles e ie ed om he sea ch s a egy will be
sc eened acco ding o he e iew inclusion and exclu-
sion c i e ia. The i les and abs ac s will be independ-
en ly sc eened by wo in es iga o s o po en ially
eligible s udies, and when he e is a di e ence in opi-
nions, discussions will be unde aken o each a consen-
sus on each a icle. I an ag eemen is no eached, a
hi d e iewe will a bi a e. The ull ex e sions o
po en ially ele an s udies will be e ie ed and
sc eened independen ly by wo e iewe s; consensus will
be ca ied ou h ough discussions and a hi d e iewe
will a bi a e i no ag eemen eached on any s udy. All
he s udies no mee ing he inclusion c i e ia will be
excluded. S udy sc eening will be unde aken and
epo ed acco ding o he P e e ed Repo ing I ems o
Sys ema ics Re iews and Me a-analyses’(PRISMA)
ecommenda ion.
24
Da a ex ac ion
A cus omised da a ex ac ion o m will be cons uc ed o
ex ac all ele an da a om each s udy. The da a
ex ac ion o m will be pilo ed on a ew o he eligible
s udies o e alua e i s eliabili y in cap u ing he s udy
da a o in e es . Da a ex ac ion will be unde aken
2El Fe kh K, e al.BMJ Open 2016;6:e010548. doi:10.1136/bmjopen-2015-010548
Open Access
g oup.bmj.com on Sep embe 25, 2016 - Published by h p://bmjopen.bmj.com/Downloaded om
independen ly by wo e iewe s. Any disag eemen s will
be esol ed by discussion o a bi a ion by a hi d
e iewe . Desc ip i e summa y ables will be p oduced o
ecapi ula e he e idence base. The ollowing da a will
be ex ac ed:
▸Au ho (s) and da e;
▸Geog aphical loca ion;
▸Resea ch design;
▸Aims;
▸Resea ch ques ions;
▸Me hods;
▸Se ings;
▸Pa icipan s (N, mean age, gende i a ailable);
▸Como bidi ies s udied;
▸Key findings;
▸Resea ch gaps iden ified.
An ini ial map will be de eloped o explo e he main
como bidi ies associa ed wi h as hma. Then he findings
will be syn hesised in a desc ip i e and a na a i e e iew
and summa ised in a concise able o acili a e he com-
pa isons o di e en como bidi ies. The eplica ion o
esul s and disc epancies will be in es iga ed. The esul s
will be hen s a ified acco ding o di e en age g oups,
gende and o he ele an indica o s o in e es . The
scoping e iew designed will be de eloped acco ding o
he Le ac e al’s
25
amewo k and he epo ing will
ollow he PRISMA checklis .
24
CONCLUSIONS
This sys ema ic scoping e iew will p o ide a comp ehen-
si e o e iew o as hma como bidi ies. We expec o
epo in he summe o 2016.
ETHICS AND DISSEMINATION
As he e a e no p ima y da a collec ed, he e will be
need o o mal Na ional Heal h Se ice e hical e iew.
The sys ema ic scoping e iew will be p esen ed a a ele-
an con e ence and be published in a pee - e iewed
jou nal.
Con ibu o s All au ho s ha e made subs an i e in ellec ual con ibu ions o
he de elopmen o his p o ocol. KEF was in ol ed in w i ing his p o ocol.
AS, CG and BN commen ed c i ically on se e al d a s o he manusc ip . KEF,
AS and BN we e in ol ed in concep ualising his e iew.
Funding This wo k is suppo ed by he Chie Scien is ’s O ice o he Sco ish
Go e nmen and As hma UK as pa o he As hma UK Cen e o Applied
Resea ch (AUK-AC-2012–01). BN is suppo ed by he Fa Ins i u e and
As hma UK Cen e o Applied Resea ch.
Compe ing in e es s None decla ed.
P o enance and pee e iew No commissioned; ex e nally pee e iewed.
Open Access This is an Open Access a icle dis ibu ed in acco dance wi h
he C ea i e Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license,
which pe mi s o he s o dis ibu e, emix, adap , build upon his wo k
non-comme cially, and license hei de i a i e wo ks on di e en e ms,
p o ided he o iginal wo k is p ope ly ci ed and he use is non-comme cial.
See: h p://c ea i ecommons.o g/licenses/by-nc/4.0/
REFERENCES
1. Global As hma Ne wo k. Global As hma Repo 2014, 2014.
2. WHO. As hma Fac Shee , 2013.
3. Global Ini ia i e o As hma. Global s a egy o as hma managemen
and p e en ion, 2012.
4. Boule LP. In luence o como bid condi ions on as hma. Eu Respi J
2009;33:897–906.
5. Boule LP, Boulay ME. As hma- ela ed como bidi ies. Expe Re
Respi Med 2011;5:377–93.
6. Ba eman ED, Boushey HA, Bousque J, e al., GOAL In es iga o s
G oup. Can guideline-de ined as hma con ol be achie ed? The
Gaining Op imal As hma Con oL s udy. Am J Respi C i Ca e Med
2004;170:836–44.
7. Cazzola M, Calze a L, Be oncelli G, e al. As hma and como bid
medical illness. Eu Respi J 2011;38:42–9.
8. Cazzola M, Seg e i A, Calze a L, e al. Como bidi ies o as hma:
cu en knowledge and u u e esea ch needs. Cu Opin Pulm Med
2013;19:36–41.
9. De G oo EP, Dui e man EJ, B and PL. Como bidi ies o as hma
du ing childhood: possibly impo an , ye poo ly s udied. Eu Respi J
2010;36:671–8.
10. Led o d DK, Lockey RF. As hma and como bidi ies. Cu Opin
Alle gy Clin Immunol 2013;13:78–86.
11. Valde as JM, S a ield B, Sibbald B, e al. De ining como bidi y:
implica ions o unde s anding heal h and heal h se ices. Ann Fam
Med 2009;7:357–63.
12. Ge shon AS, Wang C, Guan J, e al. Bu den o como bidi y in
indi iduals wi h as hma. Tho ax 2010;65:612–18.
13. Zhang T, Ca le on BC, P osse RJ, e al. The added bu den o
como bidi y in pa ien s wi h as hma. J As hma 2009;46:1021–6.
14. Blanche e CM, Gu ie ez B, O y C, e al. Economic bu den in di ec
cos s o concomi an ch onic obs uc i e pulmona y disease and
as hma in a Medica e Ad an age popula ion. J Manag Ca e Pha m
2008;14:176–85.
15. Deshmukh VM, Toelle BG, Ushe wood T, e al. The associa ion o
como bid anxie y and dep ession wi h as hma- ela ed quali y o
li e and symp om pe cep ion in adul s. Respi ology
2008;13:695–702.
16. G upp-Phelan J, Lozano P, Fishman P. Heal h ca e u iliza ion and
cos in child en wi h as hma and selec ed como bidi ies. J As hma
2001;38:363–73.
17. Leh e PM, Ka a idas MK, Lu SE, e al.Psychological ea men o
como bid as hma and panic diso de : a pilo s udy. J Anxie y Diso d
2008;22:671–83.
18. So iano JB, Visick GT, Muelle o a H, e al. Pa e ns o como bidi ies
in newly diagnosed COPD and as hma in p ima y ca e. Ches J
2005;128:2099–107.
19. Wijnho en HA, K iegsman DM, Hesselink AE, e al. The in luence o
co-mo bidi y on heal h- ela ed quali y o li e in as hma and COPD
pa ien s. Respi Med 2003;97:468–75.
20. Ge shon AS, Guan J, Wang C, e al. Co ec ion: desc ibing and
quan i ying as hma como bidi y: a popula ion s udy. PLoS ONE
2013;8:e34967.
21. Puneka YS, Sheikh A. Es ablishing he sequen ial p og ession
o mul iple alle gic diagnoses in a UK bi h coho using he
Gene al P ac ice Resea ch Da abase. Clin Exp Alle gy
2009;39:1889–95.
22. Romano A. Alle gic Rhini is and i s Impac on As hma (ARIA):
achie emen s in 10 yea s and u u e needs. J Alle gy Clin Immunol
2012.
23. Walke S, Sheikh A. Sel epo ed hini is is a signi ican p oblem o
pa ien s wi h as hma. P im Ca e Respi J 2005;14:83–7.
24. Mohe D, Shamsee L, Cla ke M, e al. P e e ed epo ing i ems o
sys ema ic e iew and me a-analysis p o ocols (PRISMA-P) 2015
s a emen . Sys Re 2015;4:1.
25. Le ac DH, Colquhoun H, O’B ien KK. Scoping s udies: ad ancing
he me hodology. Implemen Sci 2010;5:1–9.
El Fe kh K, e al.BMJ Open 2016;6:e010548. doi:10.1136/bmjopen-2015-010548 3
Open Access
g oup.bmj.com on Sep embe 25, 2016 - Published by h p://bmjopen.bmj.com/Downloaded om
sys ema ic scoping e iew p o ocol
In es iga ing as hma como bidi ies: a
Ka im El Fe kh, B igh Nwa u, Ch is G i i hs and Aziz Sheikh
doi: 10.1136/bmjopen-2015-010548
2016 6: BMJ Open
h p://bmjopen.bmj.com/con en /6/8/e010548
Upda ed in o ma ion and se ices can be ound a :
These include:
Re e ences #BIBLh p://bmjopen.bmj.com/con en /6/8/e010548
This a icle ci es 21 a icles, 5 o which you can access o ee a :
Open Access
h p://c ea i ecommons.o g/licenses/by-nc/4.0/non-comme cial. See:
p o ided he o iginal wo k is p ope ly ci ed and he use is
non-comme cially, and license hei de i a i e wo ks on di e en e ms,
pe mi s o he s o dis ibu e, emix, adap , build upon his wo k
Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license, which
This is an Open Access a icle dis ibu ed in acco dance wi h he C ea i e
se ice
Email ale ing box a he op igh co ne o he online a icle.
Recei e ee email ale s when new a icles ci e his a icle. Sign up in he
Collec ions
Topic A icles on simila opics can be ound in he ollowing collec ions
(278)Respi a o y medicine (50)Immunology (including alle gy)
(1693)Epidemiology
No es
h p://g oup.bmj.com/g oup/ igh s-licensing/pe missions
To eques pe missions go o:
h p://jou nals.bmj.com/cgi/ ep in o m
To o de ep in s go o:
h p://g oup.bmj.com/subsc ibe/
To subsc ibe o BMJ go o:
g oup.bmj.com on Sep embe 25, 2016 - Published by h p://bmjopen.bmj.com/Downloaded om