Asthma, obesity and targeted interventions: an update

Abstract

Purpose of review Obese asthma is now widely recognized as a phenotype of difficult asthma that is common and less responsive to traditional asthma treatments, so identifying specific treatments is increasingly important. Recent findings Obesity can lead to asthma through a complex relationship of causes including mechanical, inflammatory, metabolic and genetic factors. Exercise programmes including pulmonary rehabilitation, weight loss via dietary restriction, exercise and bariatric surgery, or combinations of all of these can improve quality of life, symptoms, and exercise capacity, with reductions in medication use and exacerbations, and represent tailored treatment for this phenotype of severe difficult to treat asthmatic patients. Summary Exercise programmes and pulmonary rehabilitation, weight loss programmes targeting 5–10% weight loss and bariatric surgery are effective treatments for the obese asthma phenotype.

Pubertal BMI change and adult‐onset asthma in men: Population‐based cohort study in Sweden

“…Nevertheless, subsequent cohort studies and meta‐analyses have largely supported findings from previous studies, indicating that obesity and measures of adiposity are associated with incident asthma and its clinical outcomes . In studies on weight loss, based on behavioural changes and surgical interventions, obese asthma patients who lose weight may have considerable improvements …”

Long-term prognosis of new adult-onset asthma in obese patients

“…However, more studies should be undertaken with exacerbations as an end-point. Overall, weight loss of 5–10% by lifestyle intervention has improved symptom control and quality of life in obese asthmatics [ 33 , 45 ], but whether 5–10% weight loss is enough to reduce exacerbations in the long term remains unclear.…”

Pulmonary Rehabilitation and Asthma

“…Indeed, obesity is a common comorbidity of asthma patients and obese patients are at high risk to develop difficult to treat asthma, with poor control of respiratory symptoms and reduced response to corticosteroids (Beuther and Sutherland, 2007;Sutherland, 2014;Freitas et al, 2017). Exercise and weight loss programs are effective treatments for non-obese asthma patients also Ricketts and Cowan, 2019;.…”

“…Education (Boudreau et al, 2014;Kew et al, 2016;Levy et al, 2016;Farzandipour et al, 2017;Normansell et al, 2017;Yorke et al, 2017;Donner et al, 2018;Gesinde and Harry, 2018;Schuermans et al, 2018) Increased medication technique and adherence Better asthma control Exercise (Maltais et al, 1997;Porszasz et al, 2005;Luxton et al, 2008;Borg et al, 2010;Eichenberger et al, 2013;Spruit et al, 2013;Franca-Pinto et al, 2015;Lingner et al, 2015;Turk et al, 2017;Sahin and Naz, 2019; Increased muscular endurance and strength Improved QoL Reduced bronchial inflammation, asthma symptoms, and exacerbations Physical activity (Garcia-Aymerich et al, 2009;Eijkemans et al, 2012;Coelho et al, 2018;Panagiotou et al, 2020;Physical Activity On, 2020) Reduced risk of development asthma Breathing retraining (Gosselink et al, 1995;Yamaguti et al, 2012;Duruturk et al, 2018) Increased inspiratory muscle strength Increased exercise capacity Reduced symptoms Breathing exercise (Yang et al, 2016;Bruton et al, 2018) Reduced symptoms Weight loss (Beuther and Sutherland, 2007;Stream and Sutherland, 2012;Sutherland, 2014;Freitas et al, 2017;Ricketts and Cowan, 2019) Better asthma control Reduced symptoms Psychological counseling (Yorke et al, 2017) Improved QoL Reduced anxiety…”