Burden of Type 2 and Oral Corticosteroids Related Comorbidities in Severe Asthma Patients from the Gulf Countries: A Comparative Study from The ISAR Registry

Background and Objectives: Comorbidities are common in severe asthma and can influence disease burden, and treatment outcomes. This study aimed to compare the prevalence and distribution of comorbidities potentially related to T2 inflammation and oral corticosteroid (OCS) use in severe asthma patients from Gulf countries using International Severe Asthma Registry (ISAR) data, and to assess their association with age, sex, and smoking status. Methods: Data from severe asthma patients in Kuwait (n=494), Saudi Arabia (n=398), and the UAE (n=257) were extracted from ISAR (n=16,269). Comorbidities were categorized as T2–related or OCS–related. Comparative and subgroup analyses evaluated the prevalence and distribution of these comorbidities and their associations with age, sex, and smoking status. Results: Gulf patients with severe asthma were significantly younger and had earlier disease onset compared to ISAR. T2-related comorbidities, especially allergic rhinitis and nasal polyposis were more prevalent in the Gulf, while OCS-related comorbidities such as osteoporosis, anxiety, and cardiovascular disease were markedly lower. Obesity was highly prevalent across all countries and subgroups. Significant associations were found between comorbidity types and age, sex, and smoking status, with T2 burden increasing in younger and male patients, and OCS burden remaining consistently low. Conclusion: Severe asthma patients in the Gulf showed a high prevalence of T2-related comorbidities and obesity, with fewer OCS-related conditions. These patterns vary by age, sex, and smoking, highlighting the need for personalized management in this region.