Influence of body mass index on the response to asthma controller agents

Abstract

The incidence of asthma has been positively associated with obesity. Asthma comprises diverse ''phenotypes'' reflecting heterogeneity in a number of characteristics, including response to therapy. The present authors examined whether body mass index (BMI) influenced the response to placebo, as well as to two asthma controller medications.A post hoc analysis was performed, pooling data from four double-blind, placebo-controlled studies randomising 3,073 moderate asthmatic adults to montelukast (n51,439), beclomethasone (n5894) or placebo (n5740). The primary end point was asthma control days; other end points were forced expiratory volume in one second, b-agonist use and nocturnal awakening. Analyses were conducted using BMI classification into normal (,25.0 kg?m ; 16%) categories, as well as BMI as a continuous variable.The treatment groups were balanced for BMI, demographic characteristics and parameters of asthma control. The placebo response for all end points was generally lower with increasing BMI. Similarly, the response to the inhaled corticosteroid decreased, whereas the response to the leukotriene antagonist remained stable.In conclusion, post hoc data from the present study suggested that body mass index may influence the natural history of asthma control (as reflected by response to placebo) and may differentially influence response to the two active agents, warranting explicit testing in future prospective studies.

Excessive body weight is associated with additional loss of quality of life in children with asthma

“…We know from adults that the response to different asthma medications is influenced by an increasing BMI. 24 The effect of placebo or corticosteroid treatment on asthma symptom-free days was lower in obese patients with asthma, whereas this effect was not seen in treatment with leukotriene antagonists. Data on children with asthma combined with excessive body weight are still scarce.…”

Effects of omalizumab in severe asthmatics across ages: A real life Italian experience

“…In fact, the proportion of obese subjects increased with asthma severity step, reaching the peak in the highest asthma severity step (26). Furthermore, several studies showed an inverse relationship between BMI categories and reduction in asthma control, in response to all controller therapies (ICS, antileukotrienes and ICS plus long-acting β agonist in combination) (25)(26)(27)(28)(29). Therefore, obesity can be an important factor that may have influenced the reduced response to Omalizumab in the elderly asthmatics of our study in terms of ACT level and number of exacerbations.…”

Asthma-related comorbidities

“…Sutherland et al reported a reduced in vitro response to dexamethasone in overweight and obese patients with asthma [98]. In this regard, a retrospective data ana lysis by Peters-Golden et al suggested that obese asthmatics had an attenuated response to inhaled corticosteroids, while obese and nonobese patients had a similar response to leukotriene antagonists [97]. However, adequate comparative clinical trials remain to be performed to determine their comparative effects in this population.…”

“…It has been suggested that obese asthmatic patients have an altered response to asthma medications, particularly a reduced response to inhaled corticosteroids [96,97]. Sutherland et al reported a reduced in vitro response to dexamethasone in overweight and obese patients with asthma [98].…”