OBESITY AND ASTHMAOBESITY AND ASTHMA

Dr. Enrico HefflerDr. Enrico Heffler (enrico_heffler@yahoo.it) (enrico_heffler@yahoo.it)

MD, Specialist in Allergy and Clinical ImmunologyMD, Specialist in Allergy and Clinical Immunology

Allergy and Clinical Immunology - University of Torino (Italy)

Allergy Outpatients’ Clinic- “E.Agnelli” Hospital - Pinerolo (Italy)Allergy Outpatients’ Clinic- “E.Agnelli” Hospital - Pinerolo (Italy)

Allergy Outpatients’ Clinic – Valenza, Casale Monferrato and Allergy Outpatients’ Clinic – Valenza, Casale Monferrato and Acqui Terme Hospitals (Italy)Acqui Terme Hospitals (Italy)

OBESITY

DEFINITION:

* Excessive fat in body tissues.

* The National Heart, Lung and Blood Institute (NHLBI) defines

overweight as having a body mass index (BMI) of 25 to 29.9

and obese as having a BMI of 30 or greater.

OBESITY AS A RISK FACTOR:

* Obesity increases the risk of developing many health

conditions:

OBESITY

INCREASING PREVALENCE IN WESTERN COUNTRIES:

England

16-64 yrs.

USA

20-74 yrs.

Former E. Germany25-65 yrs.

W. Samoa (urban)

25-69 yrs.

Japan

20+ yrs.

Brazil

25-64 yrs.

1982 1987 1993 1975 1989 1980 1966 1991 1995 1973 1978 1991 1985 1989 1992 1978 1991

1982 1987 1993 1975 1989 1980 1966 1991 1995 1973 1978 1991 1985 1989 1992 1978 1991

- 80

- 70

- 60

- 50

- 40

- 30

- 20

- 10

- 0

- 80

- 70

- 60

- 50

- 40

- 30

- 20

- 10

- 0

Women

Men

Pre

vale

nce

of o

besi

ty (

%)

Pre

vale

nce

of o

besi

ty (

%)

OBESITY

INCREASING PREVALENCE IN WESTERN COUNTRIES:

USA 1990 – 2004:

OBESITY

INCREASING PREVALENCE IN WESTERN COUNTRIES:

UK 1987 – 2004:

OBESITY

INCREASING PREVALENCE IN WESTERN COUNTRIES:

OBESITY

ASTHMA

INCREASING PREVALENCE IN WESTERN COUNTRIES:

OBESITY & ASTHMA

EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:

* Studies have shown 1.5-3-0 fold increase in prevalence of

asthma amongst obese patients.

OBESITY & ASTHMA

Beuther DA & Sutherland ER – Overweight, obesity, and incident asthma. A meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med 2007;175:661.666

OBESITY & ASTHMA

Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010

OBESITY & ASTHMA

EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:

* Studies have shown 1.5-3-0 fold increase in prevalence of

asthma amongst obese patients.

* Weight gain is associated with incident cases of asthma.

86.000 US registered nurses (age 26-46) who were free of asthma at the start of the study followed for 4 years. Analysis of 1596 new asthma diagnosis between 1991-95.

“ The Nurses Health Study “

OBESITY & ASTHMA

Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588

“ The Nurses Health Study “

OBESITY & ASTHMA

Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588

OBESITY & ASTHMA

Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010

OBESITY & ASTHMA

EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:

* Studies have shown 1.5-3-0 fold increase in prevalence of

asthma amongst obese patients.

* Weight gain is associated with incident cases of asthma.

* Weight loss is associated with improved asthma outcomes.

Stenius-Aarniala B et al. – Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000

OBESITY & ASTHMA

OBESITY & ASTHMA

EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:

* Studies have shown 1.5-3-0 fold increase in prevalence of

asthma amongst obese patients.

* Weight gain is associated with incident cases of asthma.

* Weight loss is associated with improved asthma outcomes.

* There is particularly compelling association between obesity

and more severe asthma, particularly in females.

Distribution of BMI among adults presenting to the ED with acute asthma.

Thomson CC et al. Chest 2003;124:795-802

OBESITY & ASTHMA

OBESITY & ASTHMA

Thomsen SF et al. – Association between obesity and asthma in a twin cohort. Allergy 2007;62:1199-1204

            

     

Chen Y et al et al – The association between obesity and asthma is stronger in non-allergic than allergic adults. Chest 2006

OBESITY & ASTHMA

MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:

OBESITY & ASTHMA

MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:

OBESITY & ASTHMA

MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:

OBESITY & ASTHMA

OBESITY & ASTHMA

Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008

Asthmatics Controls

RESPONSE TO INHALED CORTICOSTEROIDS:

OBESITY & ASTHMA

Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008

OBESITY & ASTHMA

Asthmatics Controls

Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008

RESPONSE TO INHALED CORTICOSTEROIDS:

* Obese patients with asthma seem to have a predominant

sputum neutrophilia (“noneosinophilic asthma”) associated

to more severe asthma

Reduced response to inhaled corticosteroids therapy?

* We retrospectively studied 42 patients with asthma who had

undergone assessment of airway function and inflammation

before and two months after treatment with inhale budesonide

400 mcg twice daily

(Green et al. - Analysis of induced sputum in adults with asthma. Thorax 2002; 57(10):875-879)

OBESITY & ASTHMA

Heffler E, Green RH, Brightling C and Pavord ID – submitted

PATIENTS & METHODS

PATIENTS:* 42 patients (23 males; 19 females) with asthma diagnosed in

accordance with the current international guidelinesSTUDY DESIGN:

* Potential predictive factors: BMI, age, gender, atopy, eosinophils

and neutrophils differential cell counts in induced sputum

* Response parameters: methacoline PC20FEV1, sputum eosinophils,

symptoms VAS and FEV1

Heffler E, Green RH, Brightling C and Pavord ID – submitted

RESULTS

THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:

Heffler E, Green RH, Brightling C and Pavord ID – submitted

RESULTS

THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:

Heffler E, Green RH, Brightling C and Pavord ID – submitted

RESULTS

THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:

Heffler E, Green RH, Brightling C and Pavord ID – submitted

CONCLUSIONS

* Our data are in agreement with a paper by Peters-Golden et al.

(Eur Resp J 2006) in which the response to treatment with inhaled

beclomethasone was not affected by BMI

* * The link between obesity and asthma is a hot topic in respiratory The link between obesity and asthma is a hot topic in respiratory

research and needs further investigations in order to clarify theresearch and needs further investigations in order to clarify the

consistency of itconsistency of it

Heffler E, Green RH, Brightling C and Pavord ID – submitted

OBESITY & ASTHMA

MYTH or REALITY?MYTH or REALITY?