Obesity and Asthma
Section snippets
Epidemiologic observations
Cross-sectional and case-controlled epidemiologic studies have shown a modest correlation between obesity and adult asthma prevalence, with relative risk or odds ratios ranging from 1.0 to 3.0.1, 2, 3 These studies typically controlled for commonly known confounding variables, such as socioeconomic status, activity level, diet, and age. While this effect has been seen in children and adults and in both men and women, some investigators have reported a stronger effect in women.4 The typical
Physiologic consequences of obesity relevant to asthma
The most consistently demonstrated effect of obesity on the lung is a restrictive process. Typically, obesity causes a modest reduction in total lung capacity, and a larger reduction in functional residual capacity.17, 37, 38 Lung volumes are inversely proportional to the degree of adiposity, usually measured as BMI. Furthermore, weight loss is associated with significant increases total lung capacity, functional residual capacity, and expiratory reserve volume.39
While the BMI measure is simple
Inflammatory and immunologic consequences of obesity relevant to asthma
Obesity as a disease is no longer thought of as a simple imbalance of energy intake and expenditure. In addition to its energy storage function, adipose tissue behaves like an active endocrine organ, with enhanced inflammatory activity in obesity.51 Furthermore, adipocytes have the ability to recruit circulating monocytes, and adipose tissue macrophages interact with adipocytes to augment this inflammatory signal.52, 53 Body fat distribution is important, as the phenotype of central or visceral
Obese asthma: severity versus control
Asthma is a heterogeneous disease, requiring a guideline-based but customized treatment approach based upon a careful phenotyping of the patient. Obese asthma is no exception. Perhaps one way to reconcile the studies in mice and human beings is to propose that asthma in obesity represents a unique phenotype of asthma, with somewhat different pathophysiology than asthma in lean individuals. A handful of clinical studies have tried to determine whether asthma is more severe in the obese, and
Obesity: differential response to asthma controller therapy
Inhaled corticosteroids are the foundation of controller therapy for a vast majority of asthmatics. However, their effect may be attenuated in the presence of obesity. Peters-Golden and colleagues81 performed a post-hoc analysis of four large clinical trials comparing an inhaled corticosteroid and a leukotriene modifier in adults with asthma. They reported that the placebo-adjusted clinical response to inhaled corticosteroids decreased with increasing BMI. This effect was not seen in the
Summary
Epidemiologic investigations have demonstrated that while asthma can contribute to obesity, obesity can cause or worsen asthma. Asthma incidence increases with the degree of adiposity in a dose-dependent fashion, and weight-loss studies have shown that this effect is reversible—that weight loss decreases the prevalence of asthma. While obesity does not cause airflow obstruction, it is biologically plausible that it may contribute to two of the three cardinal features of asthma: airway
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School Asthma Care During COVID-19: What We Have Learned and What We Are Learning
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :In a cross-sectional study of 43,465 children and adolescents, the strongest risk factors for COVID-19 hospitalization included obesity (adjusted risk ratio 3.07; 95% CI: 2.66–3.54).92 With respect to asthma, obesity increases the sensation of dyspnea, increases airway hyper-responsiveness, impairs immune function, and potentially reduces response to ICS therapy.93,94 More globally, obesity in childhood increases the risk of a multitude of other health conditions over the course of a lifetime including cardiovascular disease.95,96
Obesity risk class and asthma outpatient service utilization by the middle aged and elderly in Taiwan
2016, Health PolicyCitation Excerpt :Studies have found obesity is associated with asthma, and there is a growing evidence for the existence of a causal association and may significantly affect asthma risk and phenotype [26,27]. The relative risk of developing asthma increases with the severity of obesity [28]. Both general obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm in women and ≥ 102 cm in men) appears to play a role in the development of asthma [29].
Sex difference in the association between obesity and asthma in U.S. adults: Findings from a national study
2015, Respiratory MedicineCitation Excerpt :It is suggested from a genetic basis that there may be a common genetic predisposition to both obesity and asthma [40] due to an overlap of genetic foci between both conditions [41], but it remains controversial. Obesity may lead to changes in the level of energy regulating hormones from adipocytes including leptin and adiponectin [42]. The role of sex hormonal difference can be another explanation, mostly due to the sex hormone estrogen.
Regulation of adipose tissue energy availability through blood flow control in the metabolic syndrome
2012, Free Radical Biology and MedicineCitation Excerpt :Nitric oxide is exhaled in greater proportions in sleep apnea [194], but its implication is, again, ambiguous, because its circulating levels are low [195]. There is a close relationship between asthma and obesity [196,197], both being part of the MS, despite occurring also separately and disconnected. Asthma is a situation largely opposite to that of sleep apnea, the main difference being the more direct implication of the immune response in asthma [198,199] (Fig. 2).
Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme
2023, Clinical and Translational Allergy