Effect of Obesity on Clinical Presentation and Response to Treatment in Asthma

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Asthma (Impact Factor: 1.8). 10/2006; 43(7):553-8. DOI: 10.1080/02770900600859123
Source: PubMed


Obesity is a risk factor for being diagnosed with asthma, but there is conflicting evidence on whether obesity is a risk factor for lung function abnormalities characteristic of asthma. We studied a cohort of 488 subjects, 47% of whom were obese. Obese and non-obese subjects with asthma had similar airflow limitation and bronchodilator responsiveness, but obese participants had increased sleep disturbance and gastroesophageal reflux disease, higher cytokine levels, and a trend towards increased exacerbations when treated with theophylline. Obese and non-obese asthmatics have similar lung function abnormalities, but comorbidities and altered responses to medications may significantly affect asthma control in obese people.

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    • "Indeed, OCS are not used clinically in patients with inflammatory conditions to cause weight gain. Lean tissue weight gain can be beneficial in terminally ill or cachectic patients [6], but gains in fat mass are undesirable and can be detrimental especially in conditions such as asthma, osteoarthritis, and diabetes [9]. Furthermore, the perceived association of OCS with obesity and weight gain can influence patients' compliance with their prescribed medications [1]. "
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    ABSTRACT: Obesity is a serious risk factor for chronic disease, and commonly prescribed oral glucocorticoids (OCS) may be contributing to the prevalence of obesity. The objective of this review was to assess the impact of OCS on obesity in humans through effects on body weight (BW), energy intake, appetite, and body composition. An electronic search of English language peer-reviewed studies from 1973 up to March 2012 was conducted using Medline, CINAHL, EMBASE, and Cochrane databases. Original studies that addressed the effects of OCS on appetite, energy intake, BW, or body composition in adults were considered eligible. Data from 21 studies with objectively measured outcomes were extracted and assessed for quality using standardized tools. The publication year varied from 1986 to 2013, and the sample size, from 6 to 189. Energy intake was measured in 6 studies; BW, in 19 studies; energy expenditure, in 3 studies; body composition, in 6 studies; and appetite was evaluated in 3 studies. Short-term oral glucocorticoid therapy may result in small increases in energy intake but does not appear to result in increased BW, possibly due to an increase in energy expenditure. Long-term therapy may result in clinically significant weight gain. Within-subject variation due to metabolism and physical activity levels confounds the relationship. A dose-response relationship of oral glucocorticoid therapy on energy intake, appetite, BW, or body composition was not found. Additional well-designed, double-blind, placebo-controlled clinical trials that use standardized doses of OCS and assess the effects on appetite, energy intake, BW, and composition are strongly justified to confirm the findings of this review.
    Full-text · Article · Mar 2014 · Nutrition research
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    • "They found that obese patients who took theophylline had a trend towards an increased rate of exacerbations compared to placebo (8.1 versus 4.8 events per year, í µí±ƒ = 0.06) and the relative risk for exacerbation associated with obesity among patients on theophylline was 3.7 (í µí±ƒ < 0.001). There were no significant differences in response to treatment with montelukast [38] "
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    ABSTRACT: Asthma is a disease with distinct phenotypes that have implications for both prognosis and therapy. Epidemiologic studies have demonstrated an association between asthma and obesity. Further studies have shown that obese asthmatics have poor asthma control and more severe asthma. This obese-asthma group may represent a unique phenotype. The mechanisms behind poor asthma control in obese subjects remain unclear, but recent research has focused on adipokines and their effects on the airways as well as the role of oxidative stress. Both surgical and nonsurgical weight loss therapy have shown promising results with improvements in asthma control and decreased asthma severity. Comorbid conditions such as gastroesophageal reflux disease and obstructive sleep apnea may also have a role in poor asthma control in obese asthmatics. Further research is needed to define the mechanisms behind this phenotype which will guide the development of targeted therapies.
    Full-text · Article · Apr 2013 · Journal of Allergy
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    • "A similar inverse correlation between IL-6 in sputum and FEV1 was found in a cohort of severe asthmatic patients 32, while in a cohort of allergic asthmatic patients elevation of IL-6 in sputum associates with loss of central airway function 19. In obese asthmatic patients, the increased levels of IL-6 in serum also correlated with impaired lung function 33. Together, these studies indicate that the presence of IL-6 in the lung airways correlates with an impaired lung function in different subsets of asthmatic patients, and suggests that IL-6 is likely to be directly involved in the pathogenesis of asthma and the progressive loss of lung function observed in patients who remain untreated. "
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    ABSTRACT: The incidence and severity of chronic lung diseases is growing and affects between 100 and 150 million people worldwide and is associated with a significant rate of mortality. Unfortunately, the initial cause that triggers most chronic lung diseases remains unknown and current available therapies only ameliorate, but do not cure the disease. Thus, there is a need for identification of new targets and development of novel therapies especially for those most severely affected. IL-6, like other inflammatory cytokines, has been shown to be elevated in different lung diseases, but it was considered a byproduct of ongoing inflammation in the lung. However, recent studies support a dissociation of IL-6 from inflammation in the lung and suggest that this cytokine plays an active role in pathogenesis of asthma and, in all likelihood, COPD. IL-6 may therefore be a germane target for treatment of these and other chronic lung disease. Here, we provide an overview of the studies in mouse models and human patients that provide support for the involvement of IL-6 in lung diseases.
    Preview · Article · Oct 2012 · International journal of biological sciences
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