Asthma is a chronic inflammatory airways disease, estimated to affect 300 million people worldwide. Asthma management plans focus on optimisation of asthma pharmacotherapy. Lifestyle interventions also hold great promise for asthma sufferers as they are accessible, low cost and have minimal side-effects, thus making adherence more likely. This review explores lifestyle interventions that have been tested in asthma, including improving nutrition, increasing physical activity and introduction of relaxation therapies such as yoga and massage therapy. Available evidence suggests a protective effect of increasing fruit, vegetable and wholegrain intake and increasing physical activity levels in asthma. Weight loss is recommended for obese asthmatic patients, as just 5–10% weight loss has been found to improve quality of life and asthma control in most obese asthmatic patients. Other lifestyle interventions such as meditation, yoga and massage therapy show promise, with positive effects on asthma seen in some studies. However, the study protocols are highly variable and the results are inconsistent. Additional research is needed to further develop and refine recommendations regarding lifestyle modifications that can be implemented to improve asthma.Key pointsImproving diet quality, by increasing fruit, vegetable and wholegrain intake and reducing saturated fat intake, should be recommended in asthma, as there is evidence suggesting that this leads to improvements in airway inflammation, asthma control and exacerbation risk.Regular physical activity should be promoted for people with asthma, as it can improve quality of life and lung function, as well as general health.In obese asthmatic patients, weight loss should be recommended, as it leads to numerous health benefits, including improvements in asthma. Even small amounts of weight loss in adults (5–10% body weight) have been shown to improve asthma quality of life and asthma control in the majority of people with asthma.There is some evidence of benefit of meditation, yoga and breathing exercises for adults with asthma, while massage therapy shows promise in children with asthma. However, the evidence is inconsistent and more research is needed to make definitive recommendations.Educational aimsTo summarise current knowledge on lifestyle interventions in asthma.To improve awareness of how lifestyle modification can be used in asthma management.To identify areas for future research on lifestyle interventions in asthma.
BackgroundObesity is a common co-morbidity in asthma and associated with poorer asthma control, more frequent/severe exacerbations, and reduced response to asthma pharmacotherapy.ObjectiveThis review aims to compare use of all classes of asthma medications in obese (BMI≥30 kg·m−2) versus healthy weight (BMI<25 kg·m−2) subjects with asthma.DesignDatabases including CINAHL, Cochrane, EMBASE, and MEDLINE were searched for English language studies up to July 2019 that recorded medication use or dose in obese and healthy weight adults with asthma. A critical appraisal checklist was utilised for scrutinising methodologic quality of eligible studies. Meta-analysis was performed and heterogeneity was examined with the use of the χ2 test. This review was conducted based on a published protocol (PROSPERO: CRD42020148671).ResultsMeta-analysis showed that obese subjects are more likely to use asthma medications including; short-acting β2-agonists [odds ratio (OR)=1.75; 95% CI:1.17, 2.60; p=0.006, I2=41%] and maintenance oral corticosteroids (OR=1.86; 95% CI:1.49, 2.31; p<0.001, I2=0%) compared to healthy weight subjects. Inhaled corticosteroid dose (µg·day−1) was significantly higher in obese subjects (mean difference=208.14; 95% CI:107.01, 309.27; p<0.001, I2=74%). FEV1% predicted was significantly lower in obese subjects (mean difference=−5.32%; 95% CI:−6.75, −3.89; p<0.001, I2=42%), however, no significant differences were observed in FEV1/FVC% between groups.ConclusionsWe found that obese subjects with asthma have higher use of all included asthma medication classes and higher ICS doses than healthy weight asthma subjects, despite lower FEV1 and a similar FEV1/FVC%. A better understanding of the factors driving increased medication use is required to improve outcomes in this subgroup of asthmatics.
Context Short-chain fatty acids (SCFAs) derived from microbial fermentation of prebiotic soluble fibers are noted for their anti-inflammatory benefits against obese systemic inflammation. Objective A systematic review and meta-analysis were undertaken to investigate the effect of SCFAs and prebiotic interventions on systemic inflammation in obesity. Data Sources Relevant studies from 1947 to August 2019 were collected from the Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and Cochrane databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study Selection Of 61 included studies, 29 were of humans and 32 of animals. Data Extraction Methodological quality of studies was assessed using the critical appraisal checklist of the Academy of Nutrition and Dietetics. Data pertaining to population, intervention type and duration, and markers of systemic inflammation were extracted from included studies. Results Of 29 included human studies, 3 of 4 SCFA interventions and 11 of 25 prebiotic interventions resulted in a significant decrease in ≥1 biomarker of systemic inflammation. Of 32 included animal studies, 10 of 11 SCFA interventions and 18 of 21 prebiotic interventions resulted in a significant reduction of ≥1 biomarker of systemic inflammation. Meta-analysis revealed that prebiotics in humans reduced levels of plasma high-sensitivity C-reactive protein (standard mean difference [SMD], −0.83; 95%CI: −1.56 to −0.11; I2: 86%; P = 0.02) and plasma lipopolysaccharide (SMD, −1.20; 95%CI: −1.89 to −0.51; I2: 87%; P = 0.0006), and reduced TNF−α levels in animals (SMD, −0.63; 95%CI: −1.19 to −0.07; P = 0.03). Heterogeneity among supplement types, duration, and dose across studies was significant. Conclusion Evidence from this review and meta-analysis supports the use of SCFAs and prebiotics as novel aids in treatment of obese systemic inflammation. Systematic Review Registration PROSPERO registration no. CRD42020148529.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.