Abstract Rationale The real-world burden of respiratory disease and associated clinical management in patients with inflammatory bowel disease (IBD) (Crohn’s disease (CD) and ulcerative colitis (UC)) has not been described well compared with skin-related extra-intestinal manifestations. These comorbidities may arise from shared immunopathogenic mechanisms, chronic inflammation, or treatment-related effects. This study aims to assess the prevalence and current pharmacologic management of respiratory disease in the US IBD population, highlighting the need for improved collaboration between gastrointestinal and pulmonology specialists. Methods A descriptive, retrospective, analysis was conducted using real world data from Optum’s de-identified Market Clarity Data (Optum® Market Clarity) (Q4 2015-Q1 2024). Adult patient population with CD and UC aged 18 years were identified. We analysed the prevalence and burden of respiratory comorbidities, pharmacological prescribing patterns, and biomarker characteristics. Results Among 1.28 million IBD patients (CD: 568K; UC: 721K), approximately 41% of IBD patients (both CD and UC) have chronic pulmonary disease as the most common systemic comorbidity. The following respiratory comorbidities affected CD and UC patients, respectively: allergic rhinitis (30.2% and 30.9%), COPD (18.1% and 20.2%), chronic rhinosinusitis with nasal polyps (17.1% and 17.4%), and asthma (16.3% and 14.5%). The overall patient population showed high comorbidity burden (7.1 for CD and 7.5 for UC). Additionally, 25.6% CD and 31.1% UC patients had CCI (Charlon Comorbidity index) score 5. Of the pulmonary function data obtained for IBD patients, obstructive airflow (FEV1/FVC 70%) noted in 9.5% CD and 11.2% UC patients. Limited blood eosinophil and IgE data were available for 123,400 (10.4%) and 12,800 (1%) patients respectively despite the significant respiratory burden in these patients. Inhalation therapy use was low (0.2%) in all IBD patients despite the incidence of asthma and chronic pulmonary disease. Among these, majority of patients were prescribed SABA (7.4% and 7.2%) and/or ICS/LABA (3.6% and 3.76%). Family medicine (CD: 2.83%; UC: 3.67%) and internal medicine (CD: 1.79%; UC: 2.52%) were managing inhalation therapy for this patient population. Systemic corticosteroids used in IBD patients, of note, mainly by gastroenterology (CD: 761K; UC: 929K), family medicine (CD: 891K; UC:1169K), and internal medicine (CD: 723K; UC: 971K). Conclusions Respiratory comorbidities are prevalent among IBD patients yet remain inadequately recognized and treated by specialists. This is evidenced by predominance of inhalation therapy prescriptions originating from primary care providers and limited pulmonary function testing and biomarkers (eosinophils and fractional excretion of nitric oxide). Multidisciplinary management involving gastroenterologists and pulmonologists is recommended. This abstract is funded by: Sanofi
Zaheer et al. (Fri,) studied this question.