Physiological signature of late-onset nonallergic asthma of obesity

Dixon, Anne E.; Peters, Ubong; Walsh, Ryan R.; Daphtary, Nirav; Maclean, Erick S.; Hodgdon, Kevin; Kaminsky, David A.; Bates, Jason H. T.

doi:10.1183/23120541.00049-2020

Cited by 7 publications

(3 citation statements)

References 43 publications

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“…Inclusion and exclusion criteria for the study participants are published elsewhere 15 and are provided in Appendix S1 (Supplementary Information). This study includes data from LONA participants from two experimental protocols (with common baseline measurements) approved by the University of Vermont Institutional Review Board (Approval numbers, CHRMS: 15‐327 and CHRMS: 16‐060).…”

Section: Methodsmentioning

confidence: 99%

Central airway collapse is related to obesity independent of asthma phenotype

et al. 2021

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Background and objective Late‐onset non‐allergic asthma in obesity is characterized by an abnormally compliant, collapsible lung periphery; it is not known whether this abnormality exists in proximal airways. We sought to compare collapsibility of central airways between lean and obese individuals with and without asthma. Methods A cross‐sectional study comparing luminal area and shape (circularity) of the trachea, left mainstem bronchus, right bronchus intermedius and right inferior lobar bronchus at RV and TLC by CT was conducted. Results In 11 lean controls (BMI: 22.4 (21.5, 23.8) kg/m2), 10 lean individuals with asthma (23.6 (22.0, 24.8) kg/m2), 10 obese controls (45.5 (40.3, 48.5) kg/m2) and 21 obese individuals with asthma (39.2 (35.8, 42.9) kg/m2), lumen area and circularity increased significantly with an increase in lung volume from RV to TLC for all four airways (P < 0.05 for all). Changes in area and circularity with lung volume were similar in obese individuals with and without asthma, and both obese groups had severe airway collapse at RV. In multivariate analysis, change in lumen area was related to BMI and change in circularity to waist circumference, but neither was related to asthma diagnosis. Conclusion Excessive collapse of the central airways is related to obesity, and occurs in both obese controls and obese asthma. Increased airway collapse could contribute to ventilation abnormalities in obese individuals particularly at lower lung volumes, and complicate asthma in obese individuals.

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Section: Methodsmentioning

confidence: 99%

Central airway collapse is related to obesity independent of asthma phenotype

et al. 2021

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“…Importantly, obesity, considered a hallmark of a non-type 2 phenotype in other cohorts [11], was associated with lower F ENO values. In addition to altered airway mechanics [12], obesity is known to interfere with nitric oxide generation by inducible nitric oxide synthase through a lower ratio of L-arginine to asymmetric dimethylarginine, which could lead to reduced F ENO but increased oxidative stress [13].…”

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“…Christina Bal 1 , Marco Idzko 1 , Sabina Škrgat 2,3,4 , Andrea Koch 5,6 , Katrin Milger 7,8,9 , Christian Schulz 10 , Sonja Zehetmayer 11 , Eckard Hamelmann 12,16 , Roland Buhl 13,16 , Stephanie Korn 14,15,16 and collaborators from the German Asthma Net (GAN)…”

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Fraction of exhaled nitric oxide is associated with disease burden in the German Asthma Net severe asthma cohort

et al. 2022

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The fraction of exhaled nitric oxide (F ENO ) is a biomarker for type 2 asthma, reflecting the degree of local pulmonary inflammation linked to immune pathways, including interleukin (IL)-13 [1]. In clinical practice, F ENO is a reliable marker for inhaled corticosteroid (ICS) responsiveness [2] and the efficacy of biological therapies, such as those targeting IL-4/IL-13 pathways [3, 4], as well as the detection of steroid nonadherence or resistance in severe asthma [2]. The prospective Severe Asthma Registry of the German Asthma Net (GAN) enrols patients with severe asthma for in-depth assessment of phenotypes, underlying mechanisms and therapeutic strategies; GAN has been approved by respective ethics committees, with all included patients having signed informed consent [5]. Prior studies of F ENO either included patients with asthma of any severity [6] or did not involve a comprehensive analysis in a large cohort [7]. We therefore used cross-sectional data from GAN to determine the correlation of F ENO with epidemiological, laboratory, clinical, lung function, or quality of life parameters and the need for oral corticosteroid (OCS) maintenance therapy in a carefully selected severe asthma cohort to better characterise the severe asthma subtype with high F ENO values.At the time of data acquisition (October 2019), GAN included 1689 patients with severe asthma, as defined by the European Respiratory Society/American Thoracic Society [1], from multiple tertiary referral centres, mainly in Germany, but also in Slovenia, Austria and Croatia [5]. F ENO was measured using any available device, according to the manufacturer's instructions [8]. Patients were included in the analysis if a F ENO measurement was available and excluded only if essential data were missing. Consistent with German and international guidelines [1, 9], F ENO values ⩾25 ppb were considered elevated; exacerbations were defined as events requiring OCS for ⩾3 days, doubling of established OCS dose, or hospitalisation; and thresholds for lung function parameters and exacerbation frequency were established. Controlled asthma was defined by Asthma Control Questionnaire-5 (ACQ-5) score <1.5, or Asthma Control Test (ACT) score ⩾20, with better asthma quality of life defined by mini Asthma Quality of Life Questionnaire (mAQLQ) score ⩾5.4 [1, 9]. Hypoxaemia was defined as partial pressure of oxygen in the blood (P O 2 ) <72 mmHg, and obesity as body mass index (BMI) ⩾30 kg•m −2 . Total IgE cut-off was aligned with the German criteria for anti-IgE therapy of 75 U•mL −1 [9]. Information bias was addressed by requiring an online form to be completed on assessment of the patient. The study was approved by the ethics committee of the Medical University of Vienna (EK 1849/2019), as well as by further local committees as per local requirements. Since the registry was initiated as a longitudinal project, data acquisition was not selective or biased towards any hypotheses. The significance level for hypothesis testing was set to 0.05. Due to the exploratory charac...

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Allergic and non-allergic asthma phenotypes and exposure to air pollution

Pekince

Baççıoğlu

2021

Journal of Asthma

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Physiological signature of late-onset nonallergic asthma of obesity

Cited by 7 publications

References 43 publications

Central airway collapse is related to obesity independent of asthma phenotype

Central airway collapse is related to obesity independent of asthma phenotype

Fraction of exhaled nitric oxide is associated with disease burden in the German Asthma Net severe asthma cohort

Allergic and non-allergic asthma phenotypes and exposure to air pollution

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