Beneficial impact of weight loss on respiratory function in interstitial lung disease patients with obesity

Sekine, Akimasa; Wasamoto, Satoshi; Hagiwara, Eri; Yamakawa, Hideaki; Ikeda, Satoshi; Okabayashi, Hiroko; Oda, Toshiatsu; Okuda, Ryo; Kitamura, Hideya; Baba, Tomohisa; Komatsu, Shigeru; Ogura, Takashi

doi:10.1016/j.resinv.2020.10.002

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…On one hand, being obese had a cost-driving impact on pharmacological costs, whereas in nonpharmacological costs, obesity had a cost-saving influence. One study in ILD patients, illustrated how losing weight could improve lung function in obese patients [37]. This could explain why patients with normal weight incurred less pharmacological costs.…”

Section: Discussionmentioning

confidence: 99%

Costs of Pharmacological and Non-Pharmacological Interventions in Interstitial Lung Disease Management in Germany

et al. 2022

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Introduction: Interstitial lung diseases (ILDs) are associated with a high economic burden, yet prospective data of the German healthcare system are sparse. Objective: We assessed average ILD-related costs of pharmacological and non-pharmacological (hospitalizations, outpatient, rehabilitation, physiotherapy, and medical aids) interventions in ILD. Methods: We used data from the multicenter, observational, prospective Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases registry to evaluate adjusted per capita costs and cost drivers for ILD-related healthcare costs over 4 years, using generalized estimating equation regression models. Results: Idiopathic pulmonary fibrosis (IPF) had the highest annual pharmacological costs >EUR 21,000, followed by connective tissue disease-associated ILD (CTD-ILD) averaging EUR 6,000. Other idiopathic interstitial pneumonias and hypersensitivity pneumonitis averaged below EUR 2,400 and sarcoidosis below EUR 400. There were no significant differences in pharmacological costs over time. Trends in non-pharmacological costs were statistically significant. At year 1, CTD-ILD had the highest costs (EUR 7,700), while sarcoidosis had the lowest (EUR 2,547). By year 4, these declined to EUR 3,218 and EUR 232, respectively. Regarding cost drivers, the ILD subtype had the greatest impact with 75 times higher pharmacological costs in IPF and 4 times higher non-pharmacological costs in CTD-ILD, compared to the reference. Pulmonary hypertension (PH) and gastroesophageal reflux disease (GERD) triggered higher pharmacological costs, and higher values of forced vital capacity % predicted were associated with lower pharmacological and non-pharmacological costs. Conclusion: Stabilizing lung function and reducing the impact of PH and GERD are crucial in reducing the economic burden of ILD. There is an urgent need for effective treatment options, especially in CTD-ILD.

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Section: Discussionmentioning

confidence: 99%

Costs of Pharmacological and Non-Pharmacological Interventions in Interstitial Lung Disease Management in Germany

et al. 2022

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“…diffusing capacity of the lung for carbon monoxide-DLCO, and functional residual capacity-FRC), after short-term intervention in obese patients with interstitial lung disease [142]. When low caloric intake was combined with weight loss medication (sibutramine and orlistat), with a reduction in BMI of 5.3 kg/m 2 , a significant improvement in FVC was observed in the interventional group compared to the control one [143] (Figure 2).…”

Section: Therapeutic Targets To Prevent Pulmonary Dysfunction In Obesitymentioning

confidence: 97%

“…It has been demonstrated that patients with interstitial lung disease and severe obesity who underwent bariatric surgery had a dramatic improvement in pulmonary function a year after bariatric surgery [141]. Even with lower impact on weight reduction (at least 2 kg body weight reduction) than bariatric surgery, nutrition-education and dietary restrictions induced a significant improvement in main outcomes of pulmonary performance (forced vital capacity-FVC, diffusing capacity of the lung for carbon monoxide-DLCO, and functional residual capacity-FRC), after short-term intervention in obese patients with interstitial lung disease [142]. When low caloric intake was combined with weight loss medication (sibutramine and orlistat), with a reduction in BMI of 5.3 kg/m 2 , a significant improvement in FVC was observed in the interventional group compared to the control one [143] (Figure 2).…”

Section: Therapeutic Targets To Prevent Pulmonary Dysfunction In Obesitymentioning

confidence: 99%

“…Tranilast, a drug currently approved in Japan for the treatment of asthma [152], has been recently rediscovered for its ability to inhibit the NLRP3 inflammasome [153], paving the way for its use in the treatment of other NLRP3-driven diseases. In vitro studies on human macrophages have shown that treatment with tranilast reduced IL-1β secretion via direct interaction with the NLRP3 protein, inhibiting its oligomerisation and activation [142]. Of note, tranilast induced weight loss [154] and exhibited antidiabetic properties in mice via NLRP3 inhibition [155], suggesting that this drug might reduce obesity-associated comorbidities.…”

Section: Therapeutic Targets To Prevent Pulmonary Dysfunction In Obesitymentioning

confidence: 99%

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Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity

Palma

Sorice

Genchi

et al. 2022

IJMS

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Obesity is a chronic disease caused by an excess of adipose tissue that may impair health by altering the functionality of various organs, including the lungs. Excessive deposition of fat in the abdominal area can lead to abnormal positioning of the diaphragm and consequent reduction in lung volume, leading to a heightened demand for ventilation and increased exposure to respiratory diseases, such as chronic obstructive pulmonary disease, asthma, and obstructive sleep apnoea. In addition to mechanical ventilatory constraints, excess fat and ectopic deposition in visceral depots can lead to adipose tissue dysfunction, which promotes metabolic disorders. An altered adipokine-secretion profile from dysfunctional adipose tissue in morbid obesity fosters systemic, low-grade inflammation, impairing pulmonary immune response and promoting airway hyperresponsiveness. A potential target of these adipokines could be the NLRP3 inflammasome, a critical component of the innate immune system, the harmful pro-inflammatory effect of which affects both adipose and lung tissue in obesity. In this review, we will investigate the crosstalk between adipose tissue and the lung in obesity, highlighting the main inflammatory mediators and novel therapeutic targets in preventing pulmonary dysfunction.

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“…While some studies have suggested that lower body mass index (BMI) is associated with worse outcomes [7][8][9][10][11][12][13][14], others have found no significant association [2,5,[15][16][17]. Weight loss has been associated with worse outcomes in patients with pulmonary fibrosis [5,7,9,10,13,[18][19][20][21], although among overweight and obese patients, intentional weight loss may improve lung function [22,23].…”

Section: Introductionmentioning

confidence: 99%

Weight loss and outcomes in subjects with progressive pulmonary fibrosis: data from the INBUILD trial

et al. 2023

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Background Lower body mass index (BMI) and weight loss have been associated with worse outcomes in some studies in patients with pulmonary fibrosis. We analyzed outcomes in subgroups by BMI at baseline and associations between weight change and outcomes in subjects with progressive pulmonary fibrosis (PPF) in the INBUILD trial. Methods Subjects with PPF other than idiopathic pulmonary fibrosis were randomized to receive nintedanib or placebo. In subgroups by BMI at baseline (< 25, ≥ 25 to < 30, ≥ 30 kg/m2), we analyzed the rate of decline in FVC (mL/year) over 52 weeks and time-to-event endpoints indicating disease progression over the whole trial. We used a joint modelling approach to assess associations between change in weight and the time-to-event endpoints. Results Among 662 subjects, 28.4%, 36.6% and 35.0% had BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively. The rate of decline in FVC over 52 weeks was numerically greater in subjects with baseline BMI < 25 than ≥ 25 to < 30 or ≥ 30 kg/m2 (nintedanib: − 123.4, − 83.3, − 46.9 mL/year, respectively; placebo: − 229.5; − 176.9; − 171.2 mL/year, respectively). No heterogeneity was detected in the effect of nintedanib on reducing the rate of FVC decline among these subgroups (interaction p = 0.83). In the placebo group, in subjects with baseline BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively, 24.5%, 21.4% and 14.0% of subjects had an acute exacerbation or died, and 60.2%, 54.5% and 50.4% of subjects had ILD progression (absolute decline in FVC % predicted ≥ 10%) or died over the whole trial. The proportions of subjects with these events were similar or lower in subjects who received nintedanib versus placebo across the subgroups. Based on a joint modelling approach, over the whole trial, a 4 kg weight decrease corresponded to a 1.38-fold (95% CI 1.13, 1.68) increase in the risk of acute exacerbation or death. No association was detected between weight loss and the risk of ILD progression or the risk of ILD progression or death. Conclusions In patients with PPF, lower BMI at baseline and weight loss may be associated with worse outcomes and measures to prevent weight loss may be required. Trial registration:https://clinicaltrials.gov/ct2/show/NCT02999178.

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Beneficial impact of weight loss on respiratory function in interstitial lung disease patients with obesity

Cited by 12 publications

References 16 publications

Costs of Pharmacological and Non-Pharmacological Interventions in Interstitial Lung Disease Management in Germany

Costs of Pharmacological and Non-Pharmacological Interventions in Interstitial Lung Disease Management in Germany

Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity

Weight loss and outcomes in subjects with progressive pulmonary fibrosis: data from the INBUILD trial

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