Obesity, Inflammation, and Severe Asthma: an Update

Abstract

Purpose of Review Obesity-associated difficult asthma continues to be a substantial problem and, despite a move to address treatable traits affecting asthma morbidity and mortality, it remains poorly understood with limited phenotype-specific treatments. The complex association between asthma, obesity, and inflammation is highlighted and recent advances in treatment options explored. Recent Findings Obesity negatively impacts asthma outcomes and has a causal link in the pathogenesis of adult-onset asthma. Imbalance in the adipose organ found in obesity favours a pro-inflammatory state both systemically and in airways. Obesity may impact currently available asthma biomarkers, and obesity-associated asthma specific biomarkers are needed. Whilst surgical weight loss interventions are associated with improvements in asthma control and quality of life, evidence for pragmatic conservative options are sparse. Innovative approaches tackling obesity-mediated airway inflammation may provide novel therapies. Summary The immunopathological mechanisms underlying obesity-associated asthma require further research that may lead to novel therapeutic options for this disease. However, weight loss appears to be effective in improving asthma in this cohort and focus is also needed on non-surgical treatments applicable in the real-world setting.

Leptin and Asthma: What Are the Interactive Correlations?

“…Previous studies have implicated that obesity is related to asthma severity, and most obese patients with asthma respond poorly to conventional treatment (corticosteroids) [ 6 , 7 ]. Obesity has been correlated with the severity of asthma [ 8 , 9 ], the multiple mechanisms of which are relevant to genetic, hormonal, environmental, mechanical, and immunological factors [ 10 ]. There are two hypotheses about the relationship between obesity and asthma: one is diaphragm excursion due to fat deposit and limited thoracic compliance [ 10 ], and one is the immunological and inflammatory adipokines derived from adipose tissue, such as leptin and adiponectin [ 11 ].…”

Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

“…via the release of inflammatory mediators from adipose tissue) or indirectly (e.g. due to the typical dietary changes associated with obesity, such as high levels of processed fats and low levels of fibre) 140 . Increasing body mass index (BMI) is associated with increased levels of circulating inflammatory mediators and increased blood neutrophil and eosinophil counts 141 .…”

Highlighting the importance of healthy sleep patterns in the risk of adult asthma under the combined effects of genetic susceptibility: a large-scale prospective cohort study of 455 405 participants

“…Asthma is a chronic respiratory inflammatory disease characterised by variable symptoms and airflow obstruction that affects hundreds of millions of people worldwide and causes a significant global health burden. [1][2][3] This WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Individuals with asthma usually have comorbid sleep disturbances, but the relationship between baseline sleep and asthma risk is unclear. ⇒ Several sleep traits, such as insomnia and sleep duration, have been reported to be associated with asthma, but whether a comprehensive sleep pattern plays an important role in asthma risk is largely unknown.…”