obesity asthma

7/28/2019 Obesity Asthma

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OBESITY AND ASTHMA

Dr. Enrico Heffler ([email protected])

MD, 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 Valenza, Casale Monferrato and Acqui

Terme Hospitals (Italy)


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OBESITY

DEFINITION:

* Excessive fat in body tissues.

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

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

and obeseas having a BMI of 30 or greater.


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OBESITY AS A RISK FACTOR:

* Obesity increases the risk of developing many health

conditions:

OBESITY


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INCREASING PREVALENCE IN WESTERN COUNTRIES:

England

16-64 yrs.

USA

20-74 yrs.

Former E.

Germany

25-65 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

Prevalenceofobesity(%)

Prevalenceofobesity(%)

OBESITY


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USA 1990 2004:

OBESITY


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UK 1987 2004:

OBESITY


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OBESITY


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ASTHMA



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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.


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OBESITY & ASTHMA

Beuther DA & Sutherland ER Overweight, obesity, and incident asthma. A meta-analysis of prospective

epidemiologic studies.Am J Respir Crit Care Med2007;175:661.666


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OBESITY & ASTHMA

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


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OBESITY & ASTHMA




* Weight gain is associated with incident cases of asthma.


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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 Med1999;159:2582-2588


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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 Med1999;159:2582-2588


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OBESITY & ASTHMA

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


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OBESITY & ASTHMA





* Weight loss is associated with improved asthma outcomes.


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

OBESITY & ASTHMA


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OBESITY & ASTHMA





* Weight loss is associated with improved asthma outcomes.

* There is particularly compelling association between obesity

and more severe asthma, particularly in females.


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

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

OBESITY & ASTHMA


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OBESITY & ASTHMA

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


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Chen Y et al et al The association between obesity and asthma is stronger in non-allergic than allergic

adults. Chest2006

OBESITY & ASTHMA


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MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:

OBESITY & ASTHMA


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OBESITY & ASTHMA


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OBESITY & ASTHMA


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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:


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OBESITY & ASTHMA



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OBESITY & ASTHMA

Asthmatics Controls



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RESPONSE TO INHALED CORTICOSTEROIDS:

* Obese patients with asthma seem to have a predominant

sputum neutrophilia (noneosinophi l ic 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 IDsubmitted


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PATIENTS & METHODS

PATIENTS:

* 42 patients (23 males; 19 females) with asthma diagnosed inaccordance with the current international guidelines

STUDY 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



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RESULTS

THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE

AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:



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RESULTS





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RESULTS





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CONCLUSIONS

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

(Eur Resp J2006) 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

research and needs further investigations in order to clarify the

consistency of it



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OBESITY & ASTHMA

MYTH or REALITY?

obesity asthma

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