Obesity and the lung: 4 {middle dot} Obesity and asthma

Sin, DD; Sutherland, E. Rand

doi:10.1136/thx.2007.086819

Cited by 138 publications

(93 citation statements)

References 70 publications

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“…The risk of asthma increases steadily with increasing body mass index (BMI) and is higher in women (1,6). Furthermore, BMI negatively impacts asthma quality of life scores, asthma control scores, severity of exacerbations, and asthma-related hospitalizations (6)(7)(8)(9). Together, these studies suggest a role of obesity in the pathogenesis of asthma.…”

mentioning

confidence: 76%

Alveolar Macrophages from Overweight/Obese Subjects with Asthma Demonstrate a Proinflammatory Phenotype

Lugogo¹,

Hollingsworth

Howell³

et al. 2012

Am J Respir Crit Care Med

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Rationale: Obesity is associated with increased prevalence and severity of asthma. Adipose tissue macrophages can contribute to the systemic proinflammatory state associated with obesity. However, it remains unknown whether alveolar macrophages have a unique phenotype in overweight/obese patients with asthma. Objectives: We hypothesized that leptin levels would be increased in the bronchoalveolar lavage fluid from overweight/obese subjects and, furthermore, that leptin would alter the response of alveolar macrophages to bacterial LPS. Methods: Forty-two subjects with asthma and 46 healthy control subjects underwent research bronchoscopy. Bronchoalveolar lavage fluid from 66 was analyzed for the level of cellular inflammation, cytokines, and soluble leptin. Cultured primary macrophages from 22 subjects were exposed to LPS, leptin, or leptin plus LPS. Cytokines were measured in the supernatants. Measurements and Main Results: Leptin levels were increased in overweight/obese subjects, regardless of asthma status (P ¼ 0.013), but were significantly higher in overweight/obese subjects with asthma. Observed levels of tumor necrosis factor-a were highest in overweight/obese subjects with asthma. Ex vivo studies of primary alveolar macrophages indicated that the response to LPS was most robust in alveolar macrophages from overweight/obese subjects with asthma and that preexposure to high-dose leptin enhanced the proinflammatory response. Leptin alone was sufficient to induce production of proinflammatory cytokines from macrophages derived from overweight/obese subjects with asthma. Conclusions: Ex vivo studies indicate that alveolar macrophages derived from overweight/obese subjects with asthma are uniquely sensitive to leptin. This macrophage phenotype, in the context of higher levels of soluble leptin, may contribute to the pathogenesis of airway disease associated with obesity.Keywords: tumor necrosis factor-a; leptin; innate immunity; lipopolysaccharide; environmental lung disease There is an increased risk of developing asthma in individuals who are overweight and obese (subsequently referred to as overweight/obese) (1-5). The risk of asthma increases steadily with increasing body mass index (BMI) and is higher in women (1, 6). Furthermore, BMI negatively impacts asthma quality of life scores, asthma control scores, severity of exacerbations, and asthma-related hospitalizations (6-9). Together, these studies suggest a role of obesity in the pathogenesis of asthma. However, the mechanisms by which obesity may contribute to airway disease remain poorly understood.Evidence suggests that adipose tissue is metabolically active, participating not only in energy homeostasis but also in inflammation (12). Adipose tissue secretes biologically active cytokines, including tumor necrosis factor (TNF)-a and IL-6, as well as adipokines, including leptin, adiponectin, plasminogen activator inhibitor (PAI)-1, and resistin (10, 11). Obesity is associated with systemic inflammation, which is characterized by elevated serum levels of...

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mentioning

confidence: 76%

Alveolar Macrophages from Overweight/Obese Subjects with Asthma Demonstrate a Proinflammatory Phenotype

Lugogo¹,

Hollingsworth

Howell³

et al. 2012

Am J Respir Crit Care Med

View full text Add to dashboard Cite

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“…[4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting.…”

Section: Resultsmentioning

confidence: 99%

“…The median number of albuterol treatments in the inpatient setting was 14 (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. When albuterol treatments given in the ED were included, the median number of treatments increased to 38 (IQR, .…”

Section: Los and Resource Utilizationmentioning

confidence: 99%

Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for inhospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS:Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/ clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization.CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful. Pediatric hospitalizations for obesity-related conditions have doubled in the last decade, mirroring the trend of higher levels of childhood obesity in the United States. [1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting. The studies examining this association have found patients with obesity to have a longer hospital length of stay (LOS) and i...

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“…One study revealed that mice fed a sugar-rich diet had twice as much airway inflammation as mice that consumed a control diet (28) . It is also possible that the link between SSB consumption and asthma is moderated by excess adiposity, as SSB intake increases the risk of obesity (15) and obesity is highly correlated with asthma (29) . However, the study by Shi et al (7) found that the relationship between SSB consumption and asthma held even when controlling for body composition.…”

Section: Discussionmentioning

confidence: 99%

The potential link between sugar-sweetened beverage consumption and post-exercise airway narrowing across puberty: a longitudinal cohort study

Emerson

Rosenkranz

et al. 2015

Public Health Nutr.

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Objective: The prevalence of asthma is rising, presenting serious public health challenges. Recent data suggest that sugar-sweetened beverage (SSB) consumption plays a role in asthma aetiology. The purpose of the present study was to determine whether SSB consumption is linked to post-exercise airway narrowing (predictor of asthma development) across puberty. Design: Participants completed pulmonary function tests, physical activity and dietary habit questionnaires, and an exercise test to exhaustion. Setting: Community in Manhattan, Kansas, USA. Subjects: We recruited ten boys and ten girls from an original cohort of forty participants tested in our laboratory approximately 5 years prior. Participants were aged 9·7 (SD 0·9) years at baseline and 14·7 (SD 0·9) years at follow-up. Results: Pre-puberty, boys consumed 6·8 (SD 4·8) servings/week and girls consumed 6·9 (SD 3·7) servings/week, while post-puberty boys consumed 11·5 (SD 5·3) servings/week and girls consumed 7·7 (SD 4·3) servings/week. Using Pearson correlation, SSB consumption was not significantly related to postexercise airway narrowing at pre-puberty (r = − 0·35, P = 0·130). In linear regression analyses, SSB consumption was significantly related to post-exercise airway narrowing post-puberty before (standardized β = − 0·60, P = 0·005) but not after (standardized β = − 0·33, P = 0·211) adjustment for confounders. Change in SSB consumption from pre-to post-puberty was significantly associated with post-exercise airway narrowing post-puberty (r = − 0·61, P = 0·010) and change in post-exercise airway narrowing from pre-to post-puberty (r = − 0·45, P = 0·048) when assessed via Pearson correlations. Conclusions: These findings suggest a possible link between SSB consumption and asthma development during maturation. Reduced SSB intake may be a possible public health avenue for blunting rising asthma prevalence.

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Obesity and the lung: 4 {middle dot} Obesity and asthma

Cited by 138 publications

References 70 publications

Alveolar Macrophages from Overweight/Obese Subjects with Asthma Demonstrate a Proinflammatory Phenotype

Alveolar Macrophages from Overweight/Obese Subjects with Asthma Demonstrate a Proinflammatory Phenotype

Childhood obesity and in-hospital asthma resource utilization

The potential link between sugar-sweetened beverage consumption and post-exercise airway narrowing across puberty: a longitudinal cohort study

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