Asthma symptoms in obese adults: The challenge of achieving asthma control

Ulrik, Charlotte Suppli

doi:10.1586/17512433.2016.1093415

Cited by 18 publications

(20 citation statements)

References 22 publications

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“…The mechanisms involved in this association include increased bronchial hyperresponsiveness (BHR), functional respiratory decline with decreased respiratory volume and flow, chronic systemic inflammation triggered by increased levels of inflammatory cytokines and chemokines, and factors derived from adipocytes, including leptin, adiponectin, and plasminogen activator inhibitor [ 13 , 14 ]. Several other factors also appear to contribute to the increased risk of asthma in obese individuals, including changes in respiratory function, low exercise tolerance, and predisposition to gastroesophageal reflux [ 15 , 16 ].…”

Section: Reviewmentioning

confidence: 99%

“…Obesity has been associated with a higher incidence, prevalence, and severity of asthma and with altered pulmonary function, poor treatment response, and high morbidity [ 15 , 65 – 68 ]. The incidence of asthma is 1.47 times higher in obese individuals than in non-obese individuals, and a three-unit increase in BMI is associated with a 35 % increase in the risk of asthma [ 69 , 70 ].…”

Section: Reviewmentioning

confidence: 99%

“…The incidence of asthma is 1.47 times higher in obese individuals than in non-obese individuals, and a three-unit increase in BMI is associated with a 35 % increase in the risk of asthma [ 69 , 70 ]. Decreases in FRC and tidal volume in addition to sedentary lifestyle and limited ability to perform+ physical activities among obese individuals may worsen asthma symptoms [ 15 , 71 , 72 ]. In a cohort study of more than 25,000 children and adults with asthma, Schatz et al [ 73 ] showed that a higher BMI was associated with worsened asthma control and an increased risk of asthma exacerbations.…”

Section: Reviewmentioning

confidence: 99%

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Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Mafort

Rufino

Costa

et al. 2016

Multidiscip Respir Med

251

210

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Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Mafort

Rufino

Costa

et al. 2016

Multidiscip Respir Med

251

210

View full text Add to dashboard Cite

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“…2014 ]. Studies also reported obesity is associated with subsequent poor asthma control [ Schatz et al 2015 ; Ulrik, 2016 ]. However, studies to comprehensively evaluate risks associated with poor asthma control in Chinese patients were still very limited.…”

Section: Introductionmentioning

confidence: 99%

Uncontrolled asthma and its risk factors in adult Chinese asthma patients

Zhong

Lin

Zheng

et al. 2016

Ther Adv Respir Dis

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Background:Asthma affects a large number of patients in China, but relatively little is known about asthma management among Chinese patients. This study aims to estimate asthma control rate among adult Chinese patients and to identify predictors associated with uncontrolled asthma.Methods:A total of 4125 asthma patients aged ⩾17 years and representing all regions of mainland China except Tibet were surveyed. Asthma control status was assessed using the Asthma Control Test (ACT) and classified as controlled (ACT score ⩾ 20) and uncontrolled (ACT score ⩽ 19). A multivariate logistic regression model was used to identify predictors associated with uncontrolled asthma from the factors including demographics, rhinitis, allergic rhinitis, and treatment adherence.Results:Asthma was controlled in 44.9%, and uncontrolled in 55.1% of the study participants. High rates of uncontrolled asthma were found in patients with treatment nonadherence (77.3%), poor adherence (66.2%), no schooling (64.8%), or obesity (62.9%). The risk of uncontrolled asthma was much higher in the treatment nonadherence group than the complete adherence group [odds ratio (OR) = 4.55 (3.68–5.62), p < 0.001]. Other predictors for uncontrolled asthma included concomitant rhinitis [OR = 1.31 (1.14–1.50), p < 0.001], obesity [OR = 1.31 (1.05–1.64), p = 0.019], asthma duration > 3 years [OR = 1.22 (1.07–1.39), p = 0.004] and age ⩾ 45 years [OR = 1.23 (1.07–1.41), p = 0.004].Conclusions:About half of the participants in this study had uncontrolled asthma. Treatment nonadherence is one of the significant predictors, which is very strongly associated with uncontrolled asthma. Efforts should be prioritized to promote patients’ treatment adherence to improve asthma control while attention is needed on rhinitis or obesity.

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“…In these circumstances, we must be particularly careful when diagnosing asthma in obese persons and attentive to other causes of obesity-related dyspnea, such as cardiovascular disease, hypertension with left ventricle diastolic dysfunction, pulmonary hypertension associated with obstructive sleep apnea, and hypoventilation-obesity syndrome. In addition, we must confirm that the patient's symptoms are related to the objective presence of reversible airflow limitation, together with changes in lung volumes and bronchial hyperresponsiveness [43,47]. Obesity itself does not alter the bronchial response to methacholine in terms of FEV 1 values [24,35], thus making the methacholine challenge test especially useful in the diagnosis of asthma.…”

Section: Should Obesity Be Taken Into Account In the Diagnosis And Fomentioning

confidence: 98%

Obesity and Asthma: Key Clinical Questions

García‐Río¹,

Alvarez-Puebla²,

Esteban-Gorgojo³

et al. 2019

J Investig Allergol Clin Immunol

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Obesity is an asthma common comorbidity and is associated not only with its development, but also with a poorer control and higher severity of it. Recent prospective evidence supports the idea that body weight gain precedes the development of asthma, but the debate is far from over. The objective of this document is to conduct a systematic review of 3 clinical questions related to asthma and obesity: 1. Obesity and asthma: the chicken or the egg? Clinical insights from epidemiological and phenotypes studies. 2. Is obesity a confounding factor in the diagnosis and management of asthma and especially in severe or difficult-to-control asthma? 3. How obese asthma subjects respond to pharmacological treatments, and to biological drugs? Do we have effective specific interventions?. Revised epidemiological, pathological and mechanistic evidence combined with data from the intervention clinical trials do not allow us to clearly state that obesity is an asthma-causative agent. However, the complexity and heterogeneity of these two illnesses make several clinical scenarios possible. Furthermore, the diagnosis of asthma in an obese patient represents an additional clinical challenge. Physicians need to be aware of the confounding effects created by the greater symptomatic perception, the alterations of lung function and the different comorbidities that the obese subjects present. A exhaustive phenotyping of the obese asthma patient should lead us to a rational therapeutic plan, including both, the pharmacological approach and anti-obesity specific therapies including a combined plan of diet and exercise and in extreme cases, bariatric surgery.

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Asthma symptoms in obese adults: The challenge of achieving asthma control

Cited by 18 publications

References 22 publications

Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Uncontrolled asthma and its risk factors in adult Chinese asthma patients

Obesity and Asthma: Key Clinical Questions

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