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.
Highlights
Introduction to the ObeseAsthma PhenotypeObesity and asthma are major public health problems affecting large numbers of individuals across the globe
Obese asthmatics had worse quality of life and lower forced vital capacity (FVC) but no difference in asthma severity and health care utilization Obese asthmatics had more severe disease and higher utilization of inhaled salmeterol and leukotriene receptor antagonists No significant association between obesity and asthma control Obesity was associated with worsened asthma control as measured by Asthma Control Test (ACT)
Obese asthmatics had worse asthma-related quality of life, asthma control, and history of asthma related hospitalizations Obese asthmatics had worse more severe asthma based on measurement of several different factors
Summary
Obesity and asthma are major public health problems affecting large numbers of individuals across the globe. In 2010, an estimated 25.7 million people had asthma: 18.7 million adults aged 18 and over, and 7.0 million children aged 0–17 years [4] Both cross-sectional epidemiologic investigations and prospective studies have shown an association between asthma and obesity with a relative risk (RR) of up to 3.0 [5,6,7,8]. Studies have shown an association between increased BMI and asthma in women as opposed to men suggesting that there may be sex-specific differences in the association between asthma and obesity [11, 12]. This review will focus on the relationship between obesity and asthma and the most current evidence regarding an “obesity-asthma” phenotype which is thought to have worsened asthma control and severity as well as a differential response to medications
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