Differential effects of obesity on eosinophilic vs. non-eosinophilic asthma subtypes

Mukadam, Seema; Zacharias, Jamie; Henao, Maria Paula; Kraschnewski, Jennifer L.; Ishmael, Faoud T.

doi:10.1080/02770903.2017.1365886

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…Correspondingly, the number of obese patients with asthma has also risen dramatically 15 . Obesity has been found to be a distinguishing variable for clustering and classifying asthma subtypes (e.g., enriched in women with adult onset) and the obese asthmatic is more likely to become corticosteroid resistant, has a higher risk of being hospitalized and more frequently presents with severe disease 16–21 . Severe asthma is defined as asthma that requires treatment with high‐dose inhaled corticosteroids combined with a second controller and/or systemic corticosteroids to maintain control or, asthma that remains uncontrolled despite this therapy 22 .…”

Section: Introductionmentioning

confidence: 99%

Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients

et al. 2019

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In order to improve targeted therapeutic approaches for asthma patients, insights into the molecular mechanisms that differentially contribute to disease phenotypes, such as obese asthmatics or severe asthmatics, are required. Here we report immunological and microbiome alterations in obese asthmatics (n = 50, mean age = 45), non-obese asthmatics (n = 53, mean age = 40), obese non-asthmatics (n = 51, mean age = 44) and their healthy counterparts (n = 48, mean age = 39). Obesity is associated with elevated proinflammatory signatures, which are enhanced in the presence of asthma. Similarly, obesity or asthma induced changes in the composition of the microbiota, while an additive effect is observed in obese asthma patients. Asthma disease severity is negatively correlated with fecal Akkermansia muciniphila levels. Administration of A. muciniphila to murine models significantly reduces airway hyper-reactivity and airway inflammation. Changes in immunological processes and microbiota composition are accentuated in obese asthma patients due to the additive effects of both disease states, while A. muciniphila may play a non-redundant role in patients with a severe asthma phenotype.

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Section: Introductionmentioning

confidence: 99%

Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients

et al. 2019

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“…Assessment of methodological quality was performed on the 56 articles that met the review inclusion criteria, of which nine were excluded due to poor methodological quality (online supplemental table S3). 23–31 Reference lists of included studies were hand-searched. This process identified one additional article,32 which was also assessed for eligibility and methodological quality (figure 1).…”

Section: Resultsmentioning

confidence: 99%

Effect of obesity on airway and systemic inflammation in adults with asthma: a systematic review and meta-analysis

Scott

McLoughlin

et al. 2023

Thorax

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BackgroundObesity is associated with more severe asthma, however, the mechanisms responsible are poorly understood. Obesity is also associated with low-grade systemic inflammation; it is possible that this inflammation extends to the airways of adults with asthma, contributing to worse asthma outcomes. Accordingly, the aim of this review was to examine whether obesity is associated with increased airway and systemic inflammation and adipokines, in adults with asthma.MethodsMedline, Embase, CINAHL, Scopus and Current Contents were searched till 11 August 2021. Studies reporting measures of airway inflammation, systemic inflammation and/or adipokines in obese versus non-obese adults with asthma were assessed. We conducted random effects meta-analyses. We assessed heterogeneity using the I2statistic and publication bias using funnel plots.ResultsWe included 40 studies in the meta-analysis. Sputum neutrophils were 5% higher in obese versus non-obese asthmatics (mean difference (MD)=5.0%, 95% CI: 1.2 to 8.9, n=2297, p=0.01, I2=42%). Blood neutrophil count was also higher in obesity. There was no difference in sputum %eosinophils; however, bronchial submucosal eosinophil count (standardised mean difference (SMD)=0.58, 95% CI=0.25 to 0.91, p<0.001, n=181, I2=0%) and sputum interleukin 5 (IL-5) (SMD=0.46, 95% CI=0.17 to 0.75, p<0.002, n=198, I2=0%) were higher in obesity. Conversely, fractional exhaled nitric oxide was 4.5 ppb lower in obesity (MD=−4.5 ppb, 95% CI=−7.1 ppb to −1.8 ppb, p<0.001, n=2601, I2=40%). Blood C reactive protein, IL-6 and leptin were also higher in obesity.ConclusionsObese asthmatics have a different pattern of inflammation to non-obese asthmatics. Mechanistic studies examining the pattern of inflammation in obese asthmatics are warranted. Studies should also investigate the clinical relevance of this altered inflammatory response.PROSPERO registeration numberCRD42021254525.

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“…Many studies [26–28] and the American Thoracic Society have concluded that obesity is a risk factor for: (1) development of de novo asthma, and (2) for complicating management in previously-diagnosed asthmatic patients [29]. The physio-pathological mechanism of this relationship is not entirely understood [30, 31] and may differ by asthma phenotypes. Nevertheless, proinflammatory effects of leptin and other obesity-related hormones may contribute to airway hyperreactivity, and, along with the restricted lung mechanics observed in obesity, these combined effects play an important role supporting the association between obesity and asthma [25].…”

Section: Discussionmentioning

confidence: 99%

Asthma medication usage is significantly reduced following bariatric surgery

et al. 2018

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Introduction Asthma is an important healthcare problem affecting millions in the United States. Additionally, a large proportion of patients with asthma suffer from obesity. These patients exhibit poor asthma control and reduced therapy response, increasing utilization of healthcare resources. Pulmonary symptoms improve after bariatric surgery (BS), and we hypothesized that asthma medication usage would decrease following BS. Methods A retrospective data analysis was performed in adult patients from a single institution’s database. Patients with obesity using at least one asthma medication pre-operatively who underwent BS were studied for up to 3-years post-operation. Poisson generalized linear mixed models for repeated measures were used to evaluate the effects of time and procedure type on the number of asthma medication. Results Bariatric patients with at least one prescribed asthma medication (mean 1.4 ± 0.6) were included (n = 751). The mean age at time of operation was 46.8 ± 11.6 years, mean weight was 295.9 ± 57 lbs, and mean body mass index (BMI) was 49 ± 8.2 kg/m2; 87.7% were female, 33.4% had diabetes, 44.2% used gastroesophageal reflux disease (GERD) medication, and 64.4% used hypertension medication. The most common procedure was Roux-en-Y gastric bypass (79%), followed by sleeve gastrectomy (10.7%), adjustable gastric banding (8.1%), and duodenal switch (2.3%). The mean number of prescribed asthma medications among all procedures decreased by 27% at 30 days post-operation (p < 0.0001), 37% at 6 months (p < 0.0001), 44% at 1 year (p < 0.0001), and 46% at 3 years (p < 0.0001) after adjusting for risk factors. No significant differences in medication use over time between procedure types were observed. In the adjusted analysis, the mean number of asthma medications was 12% higher in patients using at least one GERD medication (p = 0.015) and 8% higher with 10-unit increase in pre-operative BMI (p = 0.006). Conclusion BS significantly decreases asthma medication use starting 30 days post-operation with a sustained reduction for up to 3 years.

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Differential effects of obesity on eosinophilic vs. non-eosinophilic asthma subtypes

Abstract: Multiple clinical features of asthma are adversely affected by obesity, which may affect eosinophilic and non-eosinophilic subtypes differently.

Cited by 13 publications

References 22 publications

Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients

Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients

Effect of obesity on airway and systemic inflammation in adults with asthma: a systematic review and meta-analysis

Asthma medication usage is significantly reduced following bariatric surgery

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