Asthma and obesity

Abstract

The prevalence and incidence of asthma have increased among obese children and adults, particularly among women. Obesity seems to be a predisposing factor for the development of asthma, but the underlying mechanisms of its influence are still uncertain. Various hypotheses have been proposed to explain the link between obesity and asthma such as a common genetic predisposition, developmental changes, altered lung mechanics, the presence of a systemic inflammatory process, and an increased prevalence of associated comorbid conditions. Over-diagnosis of asthma does not seem to be more frequent in obese compared to non-obese subjects, but the added effects of obesity on respiratory symptoms can affect asthma control assessment. Obesity can make asthma more difficult to control and is associated with a reduced beneficial effect of asthma medications. This could be due to a change in asthma phenotype, particularly evidenced as a less eosinophilic type of airway inflammation combined to the added effects of changes in lung mechanics. Weight loss is associated with a universal improvement of asthma and should be part of asthma management in the obese patient. Additional research should be conducted to better determine how obesity influences the development and clinical expression of asthma, establish the optimal management of asthma in this population and determine how obesity affects long-term asthma outcomes in these patients.

Increased prevalence of pre-school wheeze is not explained by time trends in body mass index

“…This increase could not be attributed to differences in environmental exposures, socioeconomic status or vaccination status [9,10]. Because body mass index (BMI) is increasing across the globe [2], we hypothesised that BMI played a role. We therefore sought to determine whether higher BMI in the second cohort could explain the increase in prevalence of pre-school wheezing and asthma.…”

“…Associations were not consistent in children and were found mainly for preadolescents [2,6,7]. In a birth cohort, NOAL et al [7] found that obesity and wheezing were associated in 11-year-olds but not in 15-year-olds.…”

“…Overweight and obesity have been associated with asthma, particularly in adults [1][2][3][4]. In children, findings are less consistent [2,[5][6][7].…”

“…In children, findings are less consistent [2,[5][6][7]. Different mechanisms have been proposed to explain this association, including lung mechanics, systemic inflammation and associated comorbidities [1,2,8].…”

“…A literature review highlighted 289 reports of bronchiectasis associated with RA, with the respiratory symptoms preceding joint symptoms in 90% of the reports [2], strongly suggesting that the processes in bronchiectasis predispose to RA.…”