Abstract Rationale Asthma among children in low- and middle-income countries remains under-recognized and poorly controlled. Many present with comorbidities such as obesity, allergic rhinitis, gastroesophageal reflux, obstructive sleep apnea (OSA), sensitivity to aspirin and bronchiectasis which may worsen asthma outcomes. The Managing the Impact of Difficult Asthma Score (MiDAS)score offers a multidimensional measure of disease burden that may better capture these complex interactions. The MiDAS score ranges between 9.586 and 16.976, and higher values represent a greater multimorbidity burden. Methods We analyzed data from a cohort of participants aged 9-17 years with persistent asthma living in a peri-urban community in Lima. Collected data included asthma severity, anthropometry, comorbid diagnoses, spirometry, laboratory biomarkers, and validated questionnaires. We calculated a modified score (mMiDAS) that excluded bronchiectasis as a factor due to the lack of imaging data. We evaluated associations between the mMIDAS score and measures of severity including systemic inflammation (hs-CRP) post-bronchodilator FEV1/FVC, psychological distress and healthcare utilization. Results We analyzed complete data available in 81 children (mean age 11.8 ± 2.5 years; range 9-17). We identified at least one comorbidity in 54% of children with persistent asthma. Common comorbidities included obesity (36.4%), allergic rhinitis (22.1%), and GERD (2.6%). No cases of OSA or aspirin sensitivity were reported. The mMiDAS score was associated with higher serum hs-CRP (p = 0.032). Higher multimorbidity (per 1-point mMiDAS score increase) was also associated with a post-bronchodilator FEV1/FVC 0.80 (OR 4.09; 95% CI 1.18-14.2; p = 0.027). While mean mMiDAS scores were higher among participants with anxiety (11.2 vs. 10.8; p = 0.89) or depression (11.8 vs. 10.8 ; p = 0.59), neither comparison achieved statistical significance. No significant associations were found between mMiDAS scores and emergency visits, hospitalizations, or asthma control test scores. Conclusions Multimorbidity is common in children with persistent asthma in Peru. MiDAS shows promise as amultidimensional tool for assessing multimorbidity. Its associations with systemic inflammation and airflow limitation highlights potential utility in identifying children at risk for poor outcomes and guiding integrated, multidisciplinary care in low-resource settings. Future work will include prospective chest ultrasound assessments to evaluate bronchiectasis. This abstract is funded by: Geo-Health
Llerena et al. (2026) studied this question.