Effectiveness of Complex Treatment of Patients With Early-Onset and Late-Onset Bronchial Asthma Associated With Obesity

Abstract

The objective of the study was a comparative assessment of the clinical effectiveness of atorvastatin and vitamin D effect on proteolytic activity in obese patients with BA depending on the age of BA onset. Materials and Methods. We examined 195 patients with BA and obesity and 95 apparently healthy individuals. The patients were divided into 2 groups with regard to the age of BA onset: Group I included 100 patients with early-onset asthma, and Group II included 95 patients with late-onset asthma. Patients with complete BA control at baseline and those having achieved BA control after background therapy adjustment were excluded from further study. Patients of Groups I (n = 65) and II (n = 68) were divided into subgroups A, B, and C: patients of IA (n = 23) and IIA (n = 22) subgroups received background treatment in combination with vitamin D; patients of IB (n = 20) and IIB (n = 25) subgroups – in addition to background treatment received atorvastatin; patients of IC (n = 22) and IIC (n = 21) subgroups received only background treatment. To measure TIMP-1, MMP-1, and MMP-9 levels, IBL International GMBH enzyme-linked immunosorbent assay kits (Hamburg, Germany) were used. Asthma control was assessed using ACQ-5 (Asthma Control Questionnaire-5). The study was approved by the Bioethics Committee of the Academic and Research Medical Institute of Sumy State University. The obtained results were statistically processed using the SPSS–17 program. The results of the study showed that MMP-1, MMP-9, and TIMP-1 levels in obese patients with late-onset BA were significantly higher vs. patients with early-onset BA. Background therapy and its combination with vitamin D or with atorvastatin contributed to a statistically significant decrease in the level of MMP-1, MMP-9, and TIMP-1 in patients of IA, IB, and IC subgroups. MMP-1 level decreased significantly in patients with late-onset BA in all subgroups, but it was significantly lower in patients of IIB subgroup vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). MMP-9 level decreased significantly in patients of IIA and IIB subgroups, but it was significantly lower in patients of IIB subgroup vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). This suggested that atorvastatin contributed to a more significant decrease in MMP‑9 level vs. background therapy and background therapy + vitamin D. TIMP-1 level decreased significantly only in patients of IIB subgroup and was lower vs. IIA subgroup (p = 0.001) and IIC subgroup (p = 0.001). We demonstrated higher clinical treatment efficiency in patients of the IA subgroup who received vitamin D in addition to background therapy, which was confirmed by an increase in the level of BA control compared to that in patients of the B (p = 0.01) and C (p = 0.037) subgroups. In patients with late-onset BA (IIB subgroup), atorvastatin contributed to a better BA control compared to patients of IIA and IIC subgroups. The maximum improvement of respiratory function in patients with early-onset BA was achieved with the combination of background therapy + vitamin D, while in patients with late-onset BA – with atorvastatin. Conclusions. The use of atorvastatin has a more significant impact on the level of remodeling markers, BA control, and respiratory function in obese patients with late-onset BA vs. early-onset BA. Better BA control and maximum improvement of respiratory function in obese patients with early-onset BA were achieved with the combination of background therapy + vitamin D.