<p>Biomarkers for Overweight in Adult-Onset Asthma</p>

Abstract

Overweight and obesity are associated with one of the severe phenotypes of asthma, with an increased rate of exacerbations, low level of lung function, and reduced response to corticosteroid therapy. The present study focused on identifying useful biomarkers of severity in overweight patients with adult-onset asthma using real-world data. Patients and Methods: A total of 56 patients with adult-onset asthma who visited Saga University Hospital between 2018 and 2019 were retrospectively reviewed. Overweight was defined as a body mass index (BMI) greater than 25 kg/m 2. Blood eosinophils, cytokines, and chemokines were compared between non-overweight asthma and overweight asthma patients. Results: Overweight asthma patients had a higher annual exacerbation rate, lower pulmonary function even when treated frequently with high-dose inhaled corticosteroids, and a significantly lower percentage of eosinophils and lower eosinophil count compared to nonoverweight asthma patients (p<0.01, p=0.03). Moreover, the percentage of eosinophils was significantly negatively correlated with BMI (ρ=−0.38, p<0.01) (Figure 1). On serum cytokine and chemokine analyses, the overweight asthma group included significantly more patients with a lower level of tissue growth factor α (TGF-α) (1.1 pg/mL) and higher levels of hsIL-6 (2.5 pg/mL), RANTES/CCL5 (298.5 pg/mL), and vascular endothelial growth factor A (VEGF-A) (63.7 pg/mL), than the non-overweight asthma group (p=0.02, p<0.01, p=0.02, p=0.01, respectively). Conclusion: The present study showed that overweight patients with adult-onset asthma were characterized by a higher rate of annual exacerbations and worse lung function despite treatment with high-dose inhaled corticosteroids and lower blood eosinophil counts than nonoverweight patients with asthma. On blood cytokine and chemokine analyses, a low level of TGF-α and high levels of hsIL-6, RANTES/CCL5, and VEGF-A might be biomarkers reflecting the pathophysiology in overweight patients with asthma.

Clinical Characteristics and Management Strategies for Adult Obese Asthma Patients

“… 135 Studies have also noted a higher prevalence of higher ICS dose in obese patients compared to non-obese, reflective of asthma severity in this cohort. 133 , 136–138 In addition, obesity not only was associated with a reduced response to ICS + LABA with regard to both FEV1 and FEV1/FVC ratio, but also was associated with a reduced response of ICS on FeNO. 139 …”

“… 131 The presence of obesity is also associated with a higher inflammatory state. 115 , 132 , 133 When assessing pulmonary function, particularly FEV1, the treatment time from onset to peak FEV1 was longer in obese patients treated with ICS + LABA compared to patients with a normal BMI. 134 A recent meta-analysis highlighted obese patients also had significantly lower FEV1 compared to normal BMI patients, and more likelihood to be on controller medications such as ICS, ICS + LABA, and oral corticosteroids.…”

Evaluation of the obesity influence on the life quality in patients with bronchial asthma

“…Obesity leads to systemic inflammation [7]. Adipose tissue is metabolically active and produces many hormone-like substances, cytokines, chemokines, which act locally and systemically, and also produces a large number of inflammatory mediators, which suggests an immunological link between obesity and asthma [8,9]. An important role belongs to leptin, experimental studies proved its provision the pathogenetic mechanism of the relationship between obesity and asthma and supports the inflammatory process in the bronchi [10].…”

“…The obese asthma is characterized by a more severe course. The feature of this comorbid condition is the reduced effectiveness of basic therapy with inhaled corticosteroids, which prevents optimal control of symptoms, requires increasing doses and increases the number of exacerbations and hospitalizations [9,11]. In this regard, GINA experts have identified a separate asthma with obesity phenotype [1,11,12].…”

“…Like any other comorbidity, the combination of asthma with obesity entails significant emotional, physical, and financial strains leading to the deterioration in the patient's life quality (LQ). If earlier there was a tendency to focus exclusively on the symptoms of the disease, now the WHO recommends taking into account the priorities of modern medicine and aim not only to eliminate symptoms and normalize clinical and functional parameters, but to consider the improvement of the life quality as the main criterion [9,11]. LQ is an integral indicator that reflects the degree of a person's adaptation to the disease and the ability to perform the usual functions corresponding to his social status.…”