The challenge of addressing obesity in people with poorly controlled asthma

Dixon, Anne E.; Blake, Kathryn; DiMango, Emily; Feemster, Laura C.; Johnson, Olivia; Roy, Gem; Hazucha, Heather; Harvey, Jean; McCormack, Meredith C.; Wise, Robert A.; Holbrook, Janet T.

doi:10.1002/osp4.533

Cited by 8 publications

(3 citation statements)

References 41 publications

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“…88 However, exercise interventions might be challenging for people suffering with asthma and obesity. Our own group has found that patients with obesity and asthma, which frequently affects minority populations, were associated with marked impairments in quality of life related to physical health, and low levels of physical activity, 89 suggesting that weight loss interventions that include significant exercise component will likely need to be tailored for people with marked impairments in physical health. 90 Short of weight loss, focusing on dietary quality may be another strategy to improve asthma control.…”

Section: Dietary Interventionsmentioning

confidence: 99%

Obesity and Asthma

Dixon

Que

2022

Semin Respir Crit Care Med

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Obesity is a major risk factor for the development of asthma, and the prevalence of obesity is higher in people with asthma than in the general population. Obese people often have severe asthma—recent studies in the United States suggest that 60% of adults with severe asthma are obese. Multiple mechanisms link obesity and asthma, which are discussed in this article, and these pathways contribute to different phenotypes of asthma among people with obesity. From a practical aspect, changes in physiology and immune markers affect diagnosis and monitoring of disease activity in people with asthma and obesity. Obesity also affects response to asthma medications and is associated with an increased risk of co-morbidities such as gastroesophageal reflux disease, depression, and obstructive sleep apnea, all of which may affect asthma control. Obese people may be at elevated risk of exacerbations related to increased risk of severe disease in response to viral infections. Interventions that target improved dietary quality, exercise, and weight loss are likely to be particularly helpful for this patient population.

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Section: Dietary Interventionsmentioning

confidence: 99%

Obesity and Asthma

Dixon

Que

2022

Semin Respir Crit Care Med

Self Cite

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“…Therefore, an improved adherence to usual treatment and/or a better handling of aerosol devices by the patient might have led to a better asthma control and quality of life [ 41 ]. Second, we have also to consider non-pharmacological factors such as an engagement of the patient toward a better nutrition or regular physical activity [ 42 , 43 ] as it is generally advised by the health care professionals working in our asthma clinic. Our finding is supported by the demonstration that providing patient with information about the disease, particularly by increasing patients’ knowledge of how to treat their symptoms, may improve asthma control and quality of life [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics

et al. 2023

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Purpose Asthma negatively impacts health-related quality of life (HRQL). The objective is to investigate the longitudinal relationship between HRQL in asthma and disease control, demographic and clinical objective parameters in an adult population in real-life settings. Methods We conducted a longitudinal study on adult asthmatics recruited from Liege University Hospital Asthma Clinic (Belgium) between 2011 and 2019. We selected those who had two visits and completed two patient-reported outcome measures (PROMs), the asthma control test (ACT) and the mini asthma quality of life questionnaire (AQLQ) (n = 290). AQLQ was the dependent variable. Demographic, functional and inflammatory characteristics, asthma control, and exacerbations were the independent variables. We applied generalized linear mixed models to identify the factors associated with change in AQLQ and its dimensions. Results Median (IQR) time interval between the two visits was 7 (5–19) months. Overall, median (IQR) global AQLQ increased from 4.1 (3–5.1) to 4.6 (3.4–5.9) (p < 0.0001). All AQLQ dimensions significantly improved, apart the environmental one. AQLQ improved in patients who had both step-up and step-down pharmacological treatment as well as in patients reporting no change between the two visits. The fitted models indicated that change in ACT was the main predictor of change in AQLQ (p < 0.0001). A rise in 3 units in ACT predicted an improvement of 0.5 AQLQ (AUC-ROC = 0.85; p < 0.0001). Change in BMI inversely impacted global AQLQ (p < 0.01) and its activity dimension (p < 0.0001). Conclusion Asthma control and BMI are key predictors of asthma quality of life acting in an opposite direction. AQLQ may improve without step-up in the pharmacological treatment.

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“…Late-onset non-allergic asthma developing as a complication of obesity (4)(5)(6)(7). The latter primarily affects women, exhibits low inflammatory markers, does not feature eosinophilia, and often shows improvement in airway symptoms with weight loss.…”

Section: Introductionmentioning

confidence: 99%

An Adipo-Pulmonary Axis Mediated by FABP4 Hormone Defines a Therapeutic Target Against Obesity-Induced Airway Disease

Burak,

Tuncman,

Ayci

et al. 2024

Preprint

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Obesity-related airway disease is a clinical condition without a clear description and effective treatment. Here, we define this pathology and its unique properties, which differ from classic asthma phenotypes, and identify a novel adipo-pulmonary axis mediated by FABP4 hormone as a critical mediator of obesity-induced airway disease. Through detailed analysis of murine models and human samples, we elucidate the dysregulated lipid metabolism and immunometabolic responses within obese lungs, particularly highlighting the stress response activation and downregulation of surfactant-related genes, notably SftpC. We demonstrate that FABP4 deficiency mitigates these alterations, demonstrating a key role in obesity-induced airway disease pathogenesis. Importantly, we identify adipose tissue as the source of FABP4 hormone in the bronchoalveolar space and describe strong regulation in the context of human obesity, particularly among women. Finally, our exploration of antibody-mediated targeting of circulating FABP4 unveils a novel therapeutic avenue, addressing a pressing unmet need in managing obesity-related airway disease. These findings not only define the presence of a critical adipo-pulmonary endocrine link but also present FABP4 as a therapeutic target for managing this unique airway disease that we refer to as fatty lung disease associated with obesity.Graphical AbstractOne Sentence SummaryInvestigating FABP4’s pivotal role in obesity-driven airway disease, this study unveils an adipo-pulmonary axis with potential therapeutic implications.

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The challenge of addressing obesity in people with poorly controlled asthma

Cited by 8 publications

References 41 publications

Obesity and Asthma

Obesity and Asthma

Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics

An Adipo-Pulmonary Axis Mediated by FABP4 Hormone Defines a Therapeutic Target Against Obesity-Induced Airway Disease

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