Imbalanced Coagulation in the Airway of Type-2 High Asthma with Comorbid Obesity

Abstract

Asthma is a common, chronic airway inflammatory disease marked by airway hyperresponsiveness, inflammation, and remodeling. Asthma incidence has increased rapidly in the past few decades and recent multicenter analyses have revealed several unique asthma endotypes. Of these, type-2 high asthma with comorbid obesity presents a unique clinical challenge marked by increased resistance to standard therapies and exacerbated disease development. The extrinsic coagulation pathway plays a significant role in both type-2 high asthma and obesity. The type-2 high asthma airway is marked by increased procoagulant potential, which is readily activated following damage to airway tissue. In this review, we summarize the current understanding of the role the extrinsic coagulation pathway plays in the airway of type-2 high asthma with comorbid obesity. We propose that asthma control is worsened in obesity as a result of a systemic and local airway shift towards a procoagulant and anti-fibrinolytic environment. Lastly, we hypothesize bariatric surgery as a treatment for improved asthma management in type-2 high asthma with comorbid obesity, facilitated by normalization of systemic procoagulant and pro-inflammatory mediators. A better understanding of attenuated coagulation parameters in the airway following bariatric surgery will advance our knowledge of biomolecular pathways driving asthma pathobiology in patients with obesity.

Airway fibrin formation cascade in allergic asthma exacerbation: implications for inflammation and remodeling

“…In addition, studies have shown the upregulation of tissue factor by IL-13 in Th2-type asthma [ 36 ] and enhanced thrombin formation [ 37 ], contributing to a pro-coagulant environment. Several human studies have reported presence of an excessive pro-coagulation activity in the airways with plasma exudation as a potential source of the pro-coagulation proteins, particularly in severe asthma [ 36 , 38 – 40 ]. Also, complementary studies in small animal models indicate vascular leak in inflammation is produced by cell state changes of capillary pericytes [ 30 ].…”

Stomatognathic System Changes in Obese Patients Undergoing Bariatric Surgery: A Systematic Review

“…Patients may also show food residues in the oral cavity [ 70 ], a large food bolus construct [ 27 , 31 ], gastroesophageal reflux disease [ 32 , 44 , 83 ], and oropharyngeal dysphagia (OFD) [ 55 ], a symptom that refers to the difficulty in forming or moving the food bolus toward the pharyngeal wall or toward the esophagus and which is concurrently related to difficulty in oral propulsion. OFD causes alterations in safety (possible aspiration pneumonia) and efficacy (dehydration and malnutrition), thereby increasing the morbidity and mortality of individuals experiencing this condition and, consequently, deteriorating their quality of life [ 46 , 73 ]. Other features of the swallowing function in obese patients include esophagitis or inflammation, which damages the duct that extends from the throat to the stomach [ 83 ], and binge eating disorder or compulsive behavior through binge eating, where the main characteristic is loss of control over what is eaten [ 43 , 71 ].…”