Asthma and obesity: a known association but unknown mechanism

Genetic predisposition to high BMI increases risk of early life respiratory infections and episodes of severe wheeze and asthma

BACKGROUND

High body mass index (BMI) is an established risk factor for asthma, but the underlying mechanisms remain unclear.

OBJECTIVE

To increase understanding of the BMI-asthma relationship by studying the association between genetic predisposition to higher BMI and asthma, infections and other asthma traits during childhood.

METHODS

Data were obtained from the two ongoing Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) mother-child cohorts. Polygenic risk scores for adult BMI were calculated for each child. Replication was done in the large-scale register-based Integrative Psychiatric Research (iPSYCH) cohort using data on hospitalisation for asthma and infections.

RESULTS

In the COPSAC cohorts (n=974), the adult BMI polygenic risk score was significantly associated with lower respiratory tract infections (incidence rate ratio (IRR) 1.20, 95% CI 1.08-1.33, false discovery rate p-value (pFDR)=0.005) at age 0-3 years and episodes of severe wheeze (IRR 1.30, 95% CI 1.06-1.60, pFDR=0.04) at age 0-6 years. Lower respiratory tract infections partly mediated the association between the adult BMI polygenic risk score and severe wheeze (proportion mediated: 0.59, 95% CI 0.28-2.24, p-value associated with the average causal mediation effect (pACME)=2e-16). In contrast, these associations were not mediated through the child's current BMI and the polygenic risk score was not associated with an asthma diagnosis or reduced lung function up to age 18 years. The associations were replicated in iPSYCH (n=114 283), where the adult BMI polygenic risk score significantly increased the risk of hospitalisations for lower respiratory tract infections and wheeze or asthma throughout childhood to age 18 years.

CONCLUSION

Children with genetic predisposition to higher BMI had increased risk of lower respiratory tract infections and severe wheeze, independent of the child's current BMI. These results shed further light on the complex relationship between body mass BMI and asthma.

Adipose tissue in the small airways: How much is enough to drive functional changes?

Obesity is a contributing factor to asthma severity; while it has long been understood that obesity is related to greater asthma burden, the mechanisms though which this occurs have not been fully elucidated. One common explanation is that obesity mechanically reduces lung volume through accumulation of adipose tissue external to the thoracic cavity. However, it has been recently demonstrated that there is substantial adipose tissue within the airway wall itself, and that the presence of adipose tissue within the airway wall is related to body mass index. This suggests the possibility of an additional mechanism by which obesity may worsen asthma, namely by altering the behaviour of the airways themselves. To this end, we modify Anafi & Wilson's classic model of the bistable terminal airway to incorporate adipose tissue within the airway wall in order to answer the question of how much adipose tissue would be required in order to drive substantive functional changes. This analysis suggests that adipose tissue within the airway wall on the order of 1%-2% of total airway cross-sectional area could be sufficient to drive meaningful changes, and further that these changes may interact with volume effects to magnify the overall burden.

Associations of asthma control with hypertension, cardiovascular disease, and mortality in obese individuals

The objective of this study was to assess the associations of asthma control with hypertension, cardiovascular disease, and mortality in obese individuals. We used data from the National Health and Nutrition Examination Survey (NHANES), 2001-2018. Weighted logistic regression analyses and Cox proportional hazard models were performed to evaluate the influence of asthma control on hypertension, cardiovascular disease, and mortality. A total of 2744 obese participants were included. Of them, 937 participants had poorly controlled asthma, 873 had well-controlled asthma, and 934 did not have asthma. We found that poorly controlled asthma was associated with an increased risk of angina pectoris, congestive heart failure (CHF), stroke, and all-cause mortality in obese participants, while well-controlled asthma was associated with an increased risk of CHF and all-cause mortality. Compared with patients with poorly controlled asthma, patients with well-controlled asthma were at low risk of angina pectoris (OR [odds ratio], 0.49; 95% CI [confidence interval], 0.29-0.81), heart attack (OR, 0.54; 95% CI 0.34-0.87), CHF (OR, 0.62; 95% CI 0.39-0.99), and stroke (OR, 0.45; 95% CI 0.27-0.73). The present study suggested that obese individuals with poorly controlled asthma were associated with increased risks of angina pectoris, CHF, stroke, and all-cause mortality. Well-controlled asthma had fewer negative health effects than poorly controlled asthma in obese individuals.

Stigmasterol alleviates allergic airway inflammation and airway hyperresponsiveness in asthma mice through inhibiting substance-P receptor

CONTEXT

Stigmasterol has significant anti-arthritis and anti-inflammatory effects, but its role in immune and inflammatory diseases is still unclear.

OBJECTIVE

The potential advantages of stigmasterol in asthma were explored in IL-13-induced BEAS-2B cells and asthmatic mice.

MATERIALS AND METHODS

The optimal target of stigmasterol was confirmed in asthma. After detecting the cytotoxicity of stigmasterol in BEAS-2B cells, 10 μg/mL and 20 μg/mL stigmasterol were incubated with the BEAS-2B cell model for 48 h, and anti-inflammation and antioxidative stress were verified. Asthmatic mice were induced by OVA and received 100 mg/kg stigmasterol for 7 consecutive days. After 28 days, lung tissues and BAL fluid were collected for the following study. To further verify the role of NK1-R, 0.1 μM WIN62577 (NK1-R specific antagonist), and 1 μM recombinant human NK1-R protein were applied.

RESULTS

NK1-R was the potential target of stigmasterol. When the concentration of stigmasterol is 20 μg/mL, the survival rate of BEAS-2B cells is about 98.4%, which is non-toxic. Stigmasterol exerted anti-inflammation and antioxidant stress in a dose-dependent manner and decreased NK1-R expression in IL-13-induced BEAS-2B. Meanwhile, in vivo assay also indicated the anti-inflammation and antioxidant stress of stigmasterol after OVA challenge. Stigmasterol inhibited inflammation infiltration and mucus hypersecretion, and NK1-R expression.

DISCUSSION AND CONCLUSIONS

The protective effect of stigmaterol on asthma and its underlying mechanism have been discussed in depth, providing a theoretical basis and more possibilities for its treatment of asthma.

Prevalence of falls among adult mothers in Saudi Arabia: a cross-sectional study

BACKGROUND

The prevalence of falls among mothers (18-49 years old) in Saudi Arabia has been overlooked and understudied. Therefore, the study aimed to identify the 1-year prevalence, rate of falls, and consequent injuries among mothers in Saudi Arabia.

METHODS

In this cross-sectional study, a self-administered online questionnaire, including sociodemographic data and questions related to the history of falls and consequent injuries during the past 12 months, was disseminated through social media in Saudi Arabia.

RESULTS

A convenience sample of 986 mothers were voluntarily recruited for this study with a median age of 33 years and an interquartile range of 10 years. The 1-year prevalence of falls among mothers was 14.1 % (n = 139), and 52.5 % (n = 73/139) of the fallers experienced more than one fall. Among mothers who had experienced a fall, 25.4 % (n = 33/139) experienced a fall incident during pregnancy. The reported consequences of falls were pain in 37.4 % (n = 52/139), muscle and ligament injuries in 7.2 % (n = 10/139), and fractures in 2.2 % (n = 3/139) of participants. The study's findings indicate that asthma and high cholesterol level predicts the risk of falls in mothers.

CONCLUSIONS

According to our convenience sampling, 14.1% of mothers had experienced one or more falls in the past 12 months. The increased prevalence of falls among this age group of women supports the idea that falls are not only an issue for the older adult population, but fall prevention strategies for this age range are also needed.

Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.

Alleviation of Asthma Symptoms After Ketogenic Diet: A Case Report

Asthma is a chronic disease that affects the quality of life of patients, and asthma exacerbations are often a reason for hospitalization and activity limitations. Obesity has been linked to asthma as a risk and exacerbating factor. Evidence suggests that weight reduction has a positive effect on asthma control. However, there is also debate on the role of the ketogenic diet in asthma control. Here we present a case of asthma who reported markedly improved asthma after starting a ketogenic diet in the absence of any other lifestyle change. Over the four months on the ketogenic diet, the patient reported losing 20 kg of weight, reduction in blood pressure (without antihypertensives), and complete alleviation of asthma symptoms. This case report is important as the control of asthma after a ketogenic diet is not studied well in humans and therefore needs to be studied extensively.

Increased physical activity reduces sleep disturbances in asthma: A randomized controlled trial

BACKGROUND AND OBJECTIVE

Individuals with asthma are more likely to develop sleep-disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms.

METHODS

This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre- and post-intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health-related quality of life and anxiety and depression levels were conducted.

RESULTS

Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma-symptom-free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma-related quality of life questionnaire and a reduction in anxiety symptoms.

CONCLUSION

Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms.

Association between Pulmonary Function and Body Composition in Children and Adolescents with and without Obesity

Lung function in children and adolescents with obesity must consider the coexistence of two complex and related phenomena: obesity and growth. The assessment of body composition can identify changes in respiratory dynamics arising, exclusively or jointly, from adiposity and lean body mass. This study aimed to compare pulmonary function and the dysanapsis indices of children and adolescents without asthma, with and without obesity, considering body composition, pubertal development, and physical activity practice. We performed a cross-sectional study with 69 participants, 41 (59.42%) of whom have obesity. All participants carried out spirometry and the assessment of, respectively, body composition by dual-energy X-ray absorptiometry, vital signs, pubertal development, and physical activity practice. In our data, the group with obesity had higher values of forced vital capacity (FVC) and lower values of the ratio between forced expiratory volume in one second and FVC (FEV₁/FVC). Analyzing the entire sample, we found a positive correlation between FVC and a negative correlation between FEV₁/FVC with fat mass markers. At the same time, inspiratory capacity, expiratory reserve volume, and peak expiratory flow were correlated with lean body mass markers. In addition, participants with obesity presented a lower dysanapsis index. In conclusion, children and adolescents with obesity showed increased FVC and reduced FEV₁/FVC. Our findings are possibly related to the increase in fat mass, not to lean body mass. We hypothesize that these findings are associated with the dysanaptic growth pattern, which is higher in obesity, evidenced by the reduction of the dysanapsis index.

All Types Obesity and Physical Inactivity Associated with the Risk of Activity of Daily Living Limitations Among People with Asthma

Purpose

To examine the association between all types of obesity, physical inactivity, and the risk of activity of daily living limitations in people with asthma.

Patients and Methods

In this cross-sectional study, data from 2555 people aged between 25 and 74 years were acquired from the National Survey of Midlife Development in the United States Refresher conducted between 2011 and 2014. Self-reported questions were used to specify the presence or absence of asthma and physical inactivity. All participants were categorized as having no asthma or asthma. Obesity was defined based on three distinctive indicators: body mass index, waist circumference, and waist-to-hip ratio.

Results

Logistic regression analysis showed that people with asthma who had all types of obesity alone or both all types of obesity and physical inactivity were significantly (P <0.0001) almost more than three times more likely to have limitations in the activity of daily living than those without this condition, even after adjusting for all covariates. Moreover, the odds of activity of daily living limitations were 1.69 times increased in asthma patients with physical inactivity alone, but this increase in risk was not significant (P =0.465). In addition, the odds of activity of daily living limitations were significantly (P <0.0001) more than twice independently in people with asthma aged between 60 and 74 years, female, undergraduate level of education, smoking, and having joint/bone underlying diseases.

Conclusion

The results demonstrated that the presence of all types of obesity is related to a higher risk of activity of daily living limitations in people with asthma than in those without asthma. Having both all types of obesity and physical inactivity are also linked to a greater risk of activity of daily living limitations in these patients.

The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma

Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.

Impact of lifetime body mass index trajectories on the incidence and persistence of adult asthma

BACKGROUND

High body mass index trajectories from childhood to adulthood are associated with development of some chronic diseases, but whether such trajectories influence adult asthma has not been investigated to date. Therefore, we investigated associations between body mass index trajectories from childhood to middle age (5-43 years) and incidence, persistence, and relapse of asthma from ages 43 to 53 years.

METHODS

In the Tasmanian Longitudinal Health Study (n= 4194), weight and height were recorded at 8-time points between 5 and 43 years. body mass index trajectories were developed using group-based trajectory modelling. Associations between body mass index trajectories and asthma incidence, persistence, and relapse from 43 to 53 years; bronchial hyper-responsiveness at 50 years; and bronchodilator responsiveness at 53 years were modelled using multiple logistic and linear regression.

RESULTS

Five distinct body mass index trajectories were identified: average, low, high, child high-decreasing, and child average-increasing. Compared to the average trajectory, child average-increasing and high trajectories were associated with increased risk of incident asthma (OR=2.6; 95%CI 1.1, 6.6 and OR=4.4; 1.7, 11.4, respectively) and bronchial hyper-responsiveness in middle age (OR= 2.9; 1.1, 7.5 and OR= 3.5;1.1, 11.4, respectively). No associations were observed for asthma persistence or relapse.

CONCLUSION

Participants with child average-increasing and high body mass index trajectories from childhood to middle age were at higher risk of incident adult asthma. Thus, encouraging individuals to maintain normal body mass index over the life course may help reduce the burden of adult asthma.

Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis

BACKGROUND

Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response.

METHODS

A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days.

RESULTS

Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05).

CONCLUSIONS

Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.

Time trends of overweight and obesity among schoolchildren in Kuwait over a 13-year period (2007-2019): repeated cross-sectional study

OBJECTIVES

This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the WHO, the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions.

DESIGN

Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period.

SETTING

Public primary, middle and high schools in all provinces of Kuwait.

PARTICIPANTS

Schoolchildren aged 5-19 years (n 172 603).

RESULTS

According to the WHO definition, the prevalence of overweight and obesity in schoolchildren, respectively, increased from 17·73 % and 21·37 % in 2007 to 20·19 % and 28·39 % in 2019 (Pfor trend < 0·001). There is evidence that the obesity in females (but not males) has levelled off in the period 2014-2019 according to the three definitions of obesity, which is corroborated by a similar trend in the mean of BMI-for-age Z-score.

CONCLUSION

The prevalence of obesity and overweight in schoolchildren in Kuwait has risen over the last 13 years and trends are similar across all definitions. Obesity is no longer increasing at the same pace and there is evidence that the prevalence of obesity in females has plateaued. The current level of childhood overweight and obesity is too high and requires community-based and school-based interventions.

Asthma is associated with frailty among community-dwelling adults: the GAZEL cohort

Introduction

Early management of chronic respiratory diseases (CRDs) and frailty have been identified as key targets towards healthy ageing, but the association between CRDs and frailty has been poorly investigated. We studied the association between asthma and frailty in adults of the GAZEL cohort using different definitions of asthma over the 26 years of follow-up.

Methods

Current asthma definitions are based on yearly self-reports of symptoms or medication (in 2015, constant reports or at least one report between 1990 and 2015), or on a detailed respiratory symptoms questionnaire in 2002. Frailty definition is based on weakness, fatigue, unintentional weight loss, low physical activity and mobility in 2015. Frail participants had three criteria or more, pre-frail 1 or 2, and robust 0. Multinomial regression models adjusted for age, sex, body mass index, smoking, education, marital status and comorbidities were performed.

Results

In 2015, 12 345 adults (73% men, 61 to 77 years old) were included: 3% of them reported current asthma, 1.6% had constant reports during the follow-up and 9% reported current asthma at least once. In 2015, 6% were frail, 34% pre-frail and 13% of current asthmatics and 6% of non-asthmatics were frail (adjusted OR (aOR) 2.19 (1.44 to 3.34)). Significant associations were also found with the 2002 definition (aOR 2.24 (1.73 to 2.90)), constant reports (aOR 3.67 (1.70 to 7.93)) or at least once (aOR 1.50 (1.15 to 1.98)). Current asthma was also associated with pre-frailty with the 2002 definition (aOR 1.46 (1.26 to 1.68)).

Discussion

Participants with asthma had increased risk of frailty. A better understanding of their relationship could help to define and evaluate strategies for a better ageing of asthmatics.

Effect of high-intensity interval training in adolescents with asthma: The eXercise for Asthma with Commando Joe's® (X4ACJ) trial

BACKGROUND

Higher levels of cardiorespiratory fitness are associated with reduced asthma severity and increased quality of life in those with asthma. Therefore, the purpose of this study was to evaluate the effectiveness of a 6-month high-intensity interval training (HIIT) intervention in adolescents with and without asthma.

METHODS

A total of 616 adolescents (334 boys; 13.0 ± 1.1 years, 1.57 ± 0.10 m, 52.6 ± 12.9 kg, mean ± SD), including 155 with asthma (78 boys), were recruited as part of a randomized controlled trial from 5 schools (4 control and 1 intervention). The 221 intervention participants (116 boys; 47 asthma) completed 6 months of school-based HIIT (30 min, 3 times per week, 10-30 s bouts at >90% age-predicted maximum heart rate with equal rest). At baseline, mid-intervention, post-intervention, and 3-month follow-up, measurements for 20-m shuttle run, body mass index (BMI), lung function, Pediatric Quality of Life Inventory, Paediatric Asthma Quality of Life Questionnaire, and Asthma Control Questionnaire were collected. Additionally, 69 adolescents (39 boys (of the 36 with asthma there were 21 boys)) also completed an incremental ramp test. For analysis, each group's data (intervention and control) were divided into those with and without asthma.

RESULTS

Participants with asthma did not differ from their peers in any parameter of aerobic fitness, at any time-point, but were characterized by a greater BMI. The intervention elicited a significant improvement in maximal aerobic fitness but no change in sub-maximal parameters of aerobic fitness, lung function, or quality of life irrespective of asthma status. Those in the intervention group maintained their BMI, whereas BMI significantly increased in the control group throughout the 6-month period.

CONCLUSION

HIIT represents an effective tool for improving aerobic fitness and maintaining BMI in adolescents, irrespective of asthma status. HIIT was well-tolerated by those with asthma, who evidenced a similar aerobic fitness to their healthy peers and responded equally well to a HIIT program.

Associations between Inhaled Corticosteroid in the First 6 Years of Life and Obesity Related Traits

Rationale Infants and young children might be particularly susceptible to the potential clinical side effects of inhaled corticosteroids (ICS) on body mass index (BMI), adiposity rebound and body composition, but this has rarely been studied in long-term studies in this age-group. Objective To determine the association between ICS exposure in the first 6 years of life on BMI, adiposity rebound, body composition and blood lipid levels. Methods Children from the two Copenhagen Prospective Studies on Asthma in Childhood mother-child cohorts were included. ICS use was registered prospectively to age 6 and the cumulative dose was calculated. Multiple linear regression models were used for analysis. Measurements and Main Results A total of 932 (84%) of the 1111 children from the COPSAC cohorts had data on BMI, 786 (71%) had DXA scan data at age 6 years, and 815 (73%) had adiposity rebound age calculated. 291 children (31%) received a cumulative ICS dose > 10 weeks of standard treatment before age 6. ICS treatment during 0-6 years of age was associated with an increased BMI z-score; 0.05 SD [95% CI: 0.005 to 0.09] per one-year standard treatment, p=0.03, an earlier age at adiposity rebound; -0.18 year [95% CI: -0.28 to -0.08], p=0.0006, and a 2 % increased geometric mean android fat percentage, p=0.05. ICS exposure and DXA scan data were not associated. Conclusions ICS use in early childhood was associated with increased BMI z-score at age six, an earlier adiposity rebound and a trend of association with increased android body fat percentage.

Lung function in obese children and adolescents without respiratory disease: a systematic review

BACKGROUND

Obesity in children and adolescents is associated with increased morbidity and mortality due to multisystemic impairment, including deleterious changes in lung function, which are poorly understood.

OBJECTIVES

To perform a systematic review to assess lung function in children and adolescents affected by obesity and to verify the presence of pulmonary changes due to obesity in individuals without previous or current respiratory diseases.

METHODS

A systematic search was performed in the MEDLINE-PubMed (Medical Literature Analysis and Retrieval System Online), Embase (Excerpta Medica Database) and VHL (Virtual Health Library/Brazil) databases using the terms "Lung Function" and "Pediatric Obesity" and their corresponding synonyms in each database. A period of 10 years was considered, starting in February/2008. After the application of the filters, 33 articles were selected. Using the PICOS strategy, the following information was achieved: (Patient) children and adolescents; (Intervention/exposure) obesity; (Control) healthy children and adolescents; (Outcome) pulmonary function alterations; (Studies) randomized controlled trial, longitudinal studies (prospective and retrospective studies), cross-over studies and cross-sectional studies.

RESULTS

Articles from 18 countries were included. Spirometry was the most widely used tool to assess lung function. There was high variability in lung function values, with a trend towards reduced lung function markers (FEV1/FVC, FRC, ERV and RV) in obese children and adolescents.

CONCLUSION

Lung function, measured by several tools, shows numerous markers with contradictory alterations. Differences concerning the reported results of lung function do not allow us to reach a consensus on lung function changes in children and adolescents with obesity, highlighting the need for more publications on this topic with a standardized methodology.

[Asthma and obesity: relationship and therapeutic implications in patients with asthma at the Department of Pneumology in Monastir, Tunisia]

Introduction

L’obésité et l’asthme sont deux maladies chroniques touchant des millions d’individus à travers le monde. La présence d’un lien de causalité est suggérée. L'objectif de notre travail est d'étudier le profil de l’asthmatique obèse et de déterminer la relation entre les différents paramètres de sévérité de l’asthme avec les grades de l’obésité.

Méthodes

Il s'agit d'une étude rétrospective, monocentrique, analytique menée au Service de Pneumologie et d’Allergologie au CHU Fattouma Bourguiba de Monastir portant sur 450 asthmatiques, ayant un indice de masse corporelle (IMC) ≥ 30 kg/m² avec un recul d’au moins 6 mois.

Résultats

L’âge moyen au moment du diagnostic était de 45±12.8 ans. L’IMC moyen était de 34,8±4,2 kg/m². L’asthme était bien contrôlé chez 55,3% des patients. Des critères de sévérité étaient notés dans 37.4% des cas. Selon GINA 2016, 24,2% sont traités par le palier 4. Deux phénotypes de l’asthme associé à l’obésité étaient notés. Le premier phénotype (52,4%) était caractérisé par un asthme à début précoce, associé à une fréquence plus élevée d’allergie, et des manifestations d'atopie. Le deuxième (47,6 %) était caractérisé par un asthme à début tardif, fréquemment associé au sexe féminin et un taux plus élevé de comorbidités et d’hospitalisations. Les obèses de grade II et III avaient un déficit ventilatoire important (CVF: p = 0,002 et VEMS: p = 0,007).

Conclusion

L’obésité est l’un des facteurs clefs impliqués dans le mauvais contrôle de l’asthme. Sa prise en charge, qui n'est pas encore codifiée, doit être multidisciplinaire.

Sex differences in the association between asthma incidence and modifiable risk factors in Korean middle-aged and older adults: NHIS-HEALS 10-year cohort

Background

This study investigated the sex-specific incidence of asthma and the effects of modifiable risk factors, particularly obesity, on asthma incidence among middle-aged and older individuals in Korea.

Methods

We used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), which includes health examinees aged 40–79 years in 2002–2003. In total, 459,529 participants with baseline anthropometric measurements were followed-up for 10 years and the development of asthma was evaluated (2004–2013). For subgroup analysis, 246,019 participants who had body mass index (BMI) and waist circumference (WC) measurements taken in 2008–2009 were included in the analysis of the asthma incidence for 2010–2013. Factors associated with asthma were analysed using Cox proportional hazard models.

Results

The cohort comprised 4,248,813 (men, 2,358,541; women, 1,890,272) person-years of follow-up for 2004–2013. The asthma incidence was 10.58 and 15.03 per 1000 person-years for men and women, respectively. Asthma incidence increased with age, notably so in men. Obesity based on the baseline BMI was significantly associated with asthma development in both sexes (men, HR = 1.23, 95% confidence interval (CI) = 1.13–1.34; women, HR = 1.40 95% CI = 1.32–1.48). High WC was also related to asthma incidence in both sexes with statistical significance (men, HR = 1.34, 95% CI = 1.16–1.57; women, HR = 1.19 95% CI = 1.03–1.37). Analysis of the combined effects of BMI and WC showed that men had a higher asthma risk in the group with both general obesity and abdominal obesity than in the group with non-abdominal obesity and normal BMI. However, obese women had a higher risk of asthma regardless of abdominal obesity. Similarly, smoking was associated with asthma in both sexes but drinking and physical activity showed different associations between the sexes.

Conclusions

Our results revealed that asthma incidence was substantially high at old age and lifestyle factors were associated with asthma development. Practical strategies including weight control and healthy lifestyle modification are required to prevent asthma in older people.

Fatty airways: implications for obstructive disease

Epidemiological studies report that overweight or obese asthmatic subjects have more severe disease than those of a healthy weight. We postulated that accumulation of adipose tissue within the airway wall may occur in overweight patients and contribute to airway pathology. Our aim was to determine the relationship between adipose tissue within the airway wall and body mass index (BMI) in individuals with and without asthma.Transverse airway sections were sampled in a stratified manner from post mortem lungs of control subjects (n=15) and cases of nonfatal (n=21) and fatal (n=16) asthma. The relationship between airway adipose tissue, remodelling and inflammation was assessed. The areas of the airway wall and adipose tissue were estimated by point count and expressed as area per mm of basement membrane perimeter (Pbm). The number of eosinophils and neutrophils were expressed as area densities.BMI ranged from 15 to 45 kg·m^-2 and was greater in nonfatal asthma cases (p<0.05). Adipose tissue was identified in the outer wall of large airways (Pbm >6 mm), but was rarely seen in small airways (Pbm <6 mm). Adipose tissue area correlated positively with eosinophils and neutrophils in fatal asthma (Pbm >12 mm, p<0.01), and with neutrophils in control subjects (Pbm >6 mm, p=0.04).These data show that adipose tissue is present within the airway wall and is related to BMI, wall thickness and the number of inflammatory cells. Therefore, the accumulation of airway adipose tissue in overweight individuals may contribute to airway pathophysiology.

Childhood and Adolescent Obesity in the United States: A Public Health Concern

Childhood and adolescent obesity have reached epidemic levels in the United States. Currently, about 17% of US children are presenting with obesity. Obesity can affect all aspects of the children including their psychological as well as cardiovascular health; also, their overall physical health is affected. The association between obesity and other conditions makes it a public health concern for children and adolescents. Due to the increase in the prevalence of obesity among children, a variety of research studies have been conducted to discover what associations and risk factors increase the probability that a child will present with obesity. While a complete picture of all the risk factors associated with obesity remains elusive, the combination of diet, exercise, physiological factors, and psychological factors is important in the control and prevention of childhood obesity; thus, all researchers agree that prevention is the key strategy for controlling the current problem. Primary prevention methods are aimed at educating the child and family, as well as encouraging appropriate diet and exercise from a young age through adulthood, while secondary prevention is targeted at lessening the effect of childhood obesity to prevent the child from continuing the unhealthy habits and obesity into adulthood. A combination of both primary and secondary prevention is necessary to achieve the best results. This review article highlights the health implications including physiological and psychological factors comorbidities, as well as the epidemiology, risk factors, prevention, and control of childhood and adolescent obesity in the United States.

Asthma, body mass and aerobic fitness, the relationship in adolescents: The exercise for asthma with commando Joe's® (X4ACJ) trial

Although an association has been suggested between asthma, obesity, fitness and physical activity, the relationship between these parameters remains to be elucidated in adolescents. Six-hundred and sixteen adolescents were recruited (334 boys; 13.0 ± 1.1years; 1.57 ± 0.10m; 52.6 ± 12.9kg), of which 155 suffered from mild-to-moderate asthma (78 boys). Participants completed a 20-metre shuttle run test, lung function and 7-day objective physical activity measurements and completed asthma control and quality of life questionnaires. Furthermore, 69 adolescents (36 asthma; 21 boys) completed an incremental ramp cycle ergometer test. Although participants with asthma completed significantly fewer shuttle runs than their peers, peak V̇O₂ did not differ between the groups. However, adolescents with asthma engaged in less physical activity (53.9 ± 23.5 vs 60.5 ± 23.6minutes) and had higher BMI (22.2 ± 4.8 vs 20.4 ± 3.7kg·m-2), than their peers. Whilst a significant relationship was found between quality of life and cardiorespiratory fitness according to peak V̇O₂, only BMI was revealed as a significant predictor of asthma status. The current findings highlight the need to use accurate measures of cardiorespiratory fitness rather than indirect estimates to assess the influence of asthma during adolescence. Furthermore, the present study suggests that BMI and fitness may be key targets for future interventions seeking to improve asthma quality of life.

Insomnia symptoms and asthma control-Interrelations and importance of comorbidities

BACKGROUND

Insomnia symptoms are common with asthma. The aim of the study was to analyse the associations between insomnia symptoms and asthma control, asthma severity, and asthma-related comorbidity in a community-based population.

METHODS

Adults (n = 23 875, ages 18-45) from the community-based LifeGene study answered a questionnaire on insomnia symptoms, airway symptoms, asthma diagnosis, asthma medication, and asthma-related comorbidities (chronic rhinosinusitis, gastro-oesophageal reflux, anxiety, depression, or obesity).

RESULTS

Of the participants, 1272 (5.3%) had asthma. The prevalence of any insomnia symptom was higher in participants with uncontrolled asthma (n = 201) than with controlled or partially controlled asthma (32.2% vs 19.9% and 20.1%, respectively, P < .01). There was no significant difference in the prevalence of insomnia symptoms between subjects with controlled asthma and subjects without asthma. Subjects with asthma and any asthma-related comorbidity reported more insomnia symptoms (29.0% vs 22.4%, P < .01) compared to asthmatics without comorbidity. Moreover, the prevalence was highest among subjects reporting both uncontrolled asthma and any asthma-related comorbidity (45.1%, P < .01). Uncontrolled asthma remained significantly associated with insomnia symptoms (OR 1.72 (1.15-2.56)) after adjusting for age, sex, BMI, smoking history, comorbidities, physical activity, and educational level, while medication level was not. Among asthma-related comorbidities, chronic rhinosinusitis (OR 1.62 (1.20-2.19)), obesity (1.87 (1.07-3.25)), and depression (OR 1.85 (1.34-2.55)) were independently associated with insomnia symptoms.

CONCLUSION

Uncontrolled asthma was significantly associated with insomnia symptoms, while controlled or partially controlled asthma was not. Asthma-related comorbidity is of great importance, and asthma control seems to be more important than asthma severity for insomnia symptoms.

Empagliflozin and Dulaglutide are Effective against Obesity-induced Airway Hyperresponsiveness and Fibrosis in A Murine Model

Patients with asthma with obesity experience severe symptoms, are unresponsive to conventional asthma treatment, and lack proper pharmacotherapy. Empagliflozin and dulaglutide, developed for diabetes, reduce weight, decrease insulin resistance, and exert additive effects. We evaluated the efficacy of empagliflozin, dulaglutide, and their combination on obesity-induced airway hyperresponsiveness (AHR) and lung fibrosis using a murine model. We assigned C57BL/6J mice to five groups: control, high-fat diet (HFD), and HFD with empagliflozin, dulaglutide, or both. Mice received a 12-week HFD, empagliflozin (5 days/week, oral gavage), and dulaglutide (once weekly, intraperitoneally). Both drugs significantly attenuated HFD-induced weight increase, abnormal glucose metabolism, and abnormal serum levels of leptin and insulin, and co-treatment was more effective. Both drugs significantly alleviated HFD-induced AHR, increased macrophages in bronchoalveolar lavage fluid (BALF), and co-treatment was more effective on AHR. HFD-induced lung fibrosis was decreased by both drugs alone and combined. HFD induced interleukin (IL)-17, transforming growth factor (TGF)-β1, and IL-1β mRNA and protein expression, which was significantly reduced by empagliflozin, dulaglutide, and their combination. Tumour necrosis factor (TNF)-α and IL-6 showed similar patterns without significant differences. HFD-enhanced T helper (Th) 1 and Th17 cell differentiation was improved by both drugs. Empagliflozin and dulaglutide could be a promising therapy for obesity-induced asthma and showed additive effects in combination.

Weighing in on asthma: Insights on BMI, magnesium, and hospitalizations from the Ohio Pediatric Asthma Repository

Objective: Little is known about weight status and its effects on clinical course during hospitalization for asthma exacerbation. We sought to evaluate associations between weight status, specifically body mass index (BMI), with inpatient clinical course and clinical history.Methods: We retrospectively analyzed data from 2012 to 2013 on children hospitalized for asthma exacerbation in a state-wide longitudinal cohort, the Ohio Pediatric Asthma Repository. We examined BMI continuously (z scores) and categorically, comparing overweight and obese (Ov/Ob) to non-overweight and non-obese (nOv/nOb) children. We used linear mixed models controlling for site effects to determine if BMI was related to length of stay, as determined by physiologic readiness for discharge (PRD), defined as time to albuterol spaced every 4 h, need for nonstandard care or clinical history.Results: Across six hospitals, 874 children were included in analyses. BMI was positively associated with PRD (p=.008) but this increase was unlikely to be clinically significant. Ov/Ob children were more likely than nOv/nOb to require nonstandard care with repeat magnesium dosing in intensive care after dosing in the emergency department (OR = 3.23, 95%CI 1.39-7.78). Hospitalization in the year prior to enrollment was positively associated with BMI percentile (73.3 vs. 66.0, p=.028). Sleep disordered breathing was also associated with higher BMI percentile (78.2 vs. 65.9; p=.0013).Conclusions: Ov/Ob children had similar PRD to nOv/nOb children and were prone to repeat magnesium dosing. Previous hospitalization for exacerbation was positively associated with increasing BMI percentile. Additional research should investigate differential magnesium use by weight status, quantifying risks and benefits.

Exposure to intermittent hypoxia inhibits allergic airway inflammation in a murine model of asthma

PURPOSE

Obesity increases the severity of asthma, and patients with severe asthma are often complicated with obstructive sleep apnea syndrome (OSAS), a concomitant disease of obesity. We investigated whether intermittent hypoxia (IH), which is a physiological feature of OSAS, modifies allergic airway inflammation in a murine model of asthma.

METHODS

Balb/c mice were sensitized by ovalbumin (OVA) intraperitoneally twice (days 1 and 14) and challenged with intranasal OVA three times (days 21, 22, and 23). The mice were exposed to IH either from days 1 to 24 (long exposure) or only from days 21 to 24 (short exposure). The impact of IH exposure to allergic airway inflammation was investigated using these mice models by histologic, morphometric, and molecular techniques. Additionally, the airway responsiveness to acetylcholine was also assessed.

RESULTS

OVA-sensitized and OVA-challenged mice exposed to room air (RA) showed increased total cell and eosinophil numbers in the BALF. The levels of interleukin (IL)-5 and IL-13 in the BALF also increased and goblet cell metaplasia was induced. In contrast, both long and short exposure to IH inhibited the increased total cell and eosinophil numbers. The levels of IL-5 and IL-13 in the BALF also decreased on exposure to IH. Moreover, the goblet cell hyperplasia and airway hyperresponsiveness were significantly reduced in mice exposed to IH compared to those exposed to RA.

CONCLUSIONS

These results suggest that IH may not deteriorate the asthmatic condition in a murine model of asthma.

Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma

INTRODUCTION

Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated.

OBJECTIVE

This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma.

METHODS

Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment.

RESULTS

After 3 months, the WL + E group presented a significant increase in daily step counts (3068 ± 2325 vs 729 ± 1118 steps per day) and the number of asthma symptom-free days (14.5 ± 9.6 vs 8.6 ± 11.4 d·month) compared with the WL + S group. The proportion of participants with improvements in depression symptoms (76.4% vs 16.6%) and a lower risk of developing obstructive sleep apnea (56.5% vs 16.3%) was greater in the WL + E group than that in the WL + S group (P < 0.05). Significant improvements in sleep efficiency (6.6% ± 5.1% vs 1.3% ± 4.7%) and latency (-3.7 ± 5.9 vs 0.2 ± 5.6 min) were also observed in the WL + E group.

CONCLUSIONS

Our results strongly suggest that exercise training plus a weight loss program improves DLPA, sleep efficiency, and depression and asthma symptoms in obese adults with asthma.

The relationship between weight stigma, weight bias internalization, and physical health in military personnel with or at high-risk of overweight/obesity

Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m²). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p =  .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.

Acculturation is associated with asthma burden and pulmonary function in Latino youth: The GALA II study

BACKGROUND

Acculturation is an important predictor of asthma in Latino youth, specifically Mexican Americans. Less is known about acculturation and pulmonary function measures.

OBJECTIVE

We sought to estimate the association of acculturation measures with asthma and pulmonary function in Latino youth and determine whether this association varies across Latino subgroups.

METHODS

We included 1849 Latinos (302 Caribbean Spanish, 193 Central or South Americans, 1136 Mexican Americans, and 218 other Latino children) aged 8 to 21 years from 4 urban regions in the United States. Acculturation measures include nativity status, age of immigration, language of preference, and generation in the United States. We used multivariable logistic and linear regression models to quantify the association of acculturation factors with the presence of asthma (case-control study) and pulmonary function (case-only study), adjusting for demographic, socioenvironmental, and clinical variables.

RESULTS

For all acculturation measures (nativity status, age of immigration, language of preference, and generation in the United States), greater levels of acculturation were associated with greater odds of asthma. Among cases, high (English preference) and medium (equal preference for Spanish and English) levels of language acculturation were associated with decreased bronchodilator response compared with low (Spanish preference) levels (P = .009 and .02, respectively). Similarly, high language acculturation was associated with increased FEV₁ compared with low language acculturation (P = .02). There was insufficient evidence of heterogeneity for associations across Latino subgroups.

CONCLUSIONS

Acculturation was associated with diagnosed asthma and pulmonary function in Latino children and is an important factor to consider in the management of Latino youth with asthma.

Visceral Fat Accumulation Is Associated with Asthma in Patients with Type 2 Diabetes

OBJECTIVE

The number of patients with type 2 diabetes has increased in Japan, and type 2 diabetes has attracted attention as a risk factor for asthma. However, the risk factors for the development of asthma in patients with type 2 diabetes have not been determined. This study was performed to clarify whether visceral fat accumulation (VFA) and insulin resistance are risk factors for the development of asthma in patients with type 2 diabetes.

MATERIALS AND METHODS

A cross-sectional study was conducted. The study group comprised 15 patients with type 2 diabetes with asthma, and the control group comprised 145 patients with type 2 diabetes without asthma. Their fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. Their glucose status was assessed by measuring the fasting plasma glucose (FPG) concentration, fasting immunoreactive insulin concentration, homeostasis model assessment (HOMA) index, and hemoglobin A1c concentration.

RESULTS

Among patients with type 2 diabetes, VFA was significantly greater in patients with asthma than those without asthma (P < 0.0001). The FPG concentration, fasting immunoreactive insulin concentration, and HOMA index were higher in patients with asthma than those without asthma (P < 0.05, P < 0.0001, and P < 0.0001, respectively). Multiple logistic regression analysis showed that VFA and the HOMA index were significantly associated with asthma in patients with type 2 diabetes (odds ratio, 1.78; 95% confidence interval, 1.31-3.89; P = 0.0115 and odds ratio, 3.65; 95% confidence interval, 1.37-7.85; P = 0.0078, respectively).

CONCLUSIONS

Our data suggest that VFA and insulin resistance are associated with the development of asthma in patients with type 2 diabetes.

Comparisons between 2015 US asthma prevalence and two measures of asthma burden by racial/ethnic group

Objective: Asthma affects approximately 20,383,000 Americans and costs the US $56 billion dollars annually. Asthma burden is not uniform across different racial/ethnic groups. Although annual asthma prevalences by racial/ethnic group are provided by the CDC, these numbers do not account for the influence of other sociodemographic and clinical factors. In this study, we evaluated several measures of asthma burden that controlled for sociodemographic and clinical factors and compared them to 2015 CDC asthma prevalences by racial/ethnic group. Methods: We obtained unadjusted asthma predictions directly from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. To estimate average adjusted predictions (AAP) and adjusted predictions at the means (APM) for asthma, we controlled for sociodemographic and clinical factors through logistic models and subsequently calculated marginal probabilities for these results. Results: We found substantial differences at the national and state level between unadjusted prevalences and AAPs and APMs for asthma by race/ethnicity group. In addition, states that had the highest and lowest unadjusted prevalences differed from states that had the highest and lowest AAPs and APMs. For unadjusted prevalences, AAPs, and APMs, we found that states that had the highest prevalences or probabilities of asthma for Whites tended to have the widest disparities between the estimates for Whites and those of other races. Conclusions: The study's results highlight the need to account for sociodemographic and clinical factors when addressing asthma burden by racial/ethnic group across the US.

Serum periostin is associated with body mass index and allergic rhinitis in healthy and asthmatic subjects

BACKGROUND

Many studies have attempted to clarify the factors associated with serum periostin levels in asthmatic patients. However, these results were based on studies of subjects mainly characterized by high eosinophil counts, which may present as an obstacle for clarification in the identification of other factors associated with serum periostin levels. The aim of this study was to determine the factors associated with serum periostin levels in healthy subjects. We also assessed some factors in asthmatic subjects to confirm their extrapolation for management of asthma.

METHODS

Serum periostin levels were measured in 230 healthy subjects. Clinical factors of interest included body mass index (BMI) and allergic rhinitis (AR). Additionally, we confirmed whether these factors were associated with serum periostin in 206 asthmatic subjects. We further evaluated several obesity-related parameters, such as abdominal fat distribution and adipocytokine levels.

RESULTS

Smoking status, blood eosinophil count, total immunoglobulin E, and the presence of AR were associated with serum periostin in healthy subjects. There was a negative association between BMI and serum periostin in both healthy and asthmatic subjects, while there was a tendency of a positive association with AR in asthmatic subjects. There were no differential associations observed for subcutaneous and abdominal fat in relation to serum periostin in asthmatic subjects. Serum periostin was significantly associated with serum levels of adiponectin, but not with leptin.

CONCLUSIONS

Our results provided clarity as to the factors associated with serum periostin levels, which could be helpful in the interpretation of serum periostin levels in clinical practice.

Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children

PURPOSE

The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma.

METHODS AND DESIGN

Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management.

RESULTS

Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions.

PRACTICE IMPLICATIONS

Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.

Association between lipid profile and the prevalence of asthma: a meta-analysis and systemic review

OBJECTIVE

To explore the association of asthma with serum levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglyceride.

METHODS

PubMed, Cochrane, and Embase databases were systematically searched through November 2015 using the following search terms: dyslipidemia, HDL, LDL, triglyceride, cholesterol, and asthma. Eligible studies included randomized controlled trials (RCTs), retrospective, cohort, and cross-sectional studies. Sensitivity analysis and publication bias were performed.

RESULTS

Twenty studies were included in the analysis, with a total 32,604 patients (3,458 in the asthma group and 29,146 in the control group). The pooled analysis found that the mean difference between groups was significantly higher in the asthma group for levels of LDL (6.026 mg/dL, 95% CI = 2.696-9.356, p < .001) and total cholesterol (8.161 mg/dL, 95% CI = 3.006-13.316, p = .002) compared with the control group. No association was observed between asthma and control groups for levels of HDL (mean difference = -0.728, 95% CI = -3.146-1.691, p = .555) or triglycerides (mean difference = 1.436, 95% CI = -2.768-5.640, p = .503).

CONCLUSIONS

Levels of LDL and total cholesterol were higher in patients with asthma than non-asthmatic patients.

High-fat-diet induces airway hyperresponsiveness partly through activating CD38 signaling pathway

CD38 is a plasma membrane bound multifunctional enzyme. It can be activated by inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-13, inducing calcium responses to agonist in airway smooth muscle cells (ASMC). Previous studies have found that high-fat-diet (HFD) induced obesity exhibited innate airway hyperresponsiveness (AHR). This study aimed to detect the effect of CD38 signaling pathway on the AHR of overweight/obese mice. The HFD-fed mice exhibited a significantly higher baseline airway resistance (Rn), and the increasing rates of Rn responded to increasing doses of methacholine compared with the LFD-fed mice. High-fat-diet increased CD38 expressions both in lung tissues and primary cultured ASMCs. Besides, preincubation with TNF-α led to a higher expression of CD38 protein and increased intracellular calcium in ASMC of the HFD-fed mice. Furthermore, CD38 gene knockdown through transfection of CD38 siRNA decreased the concentration of intracellular calcium. Additionally, the upregulations of CD38 protein and CD38 mRNA were also found in the lung tissues of HFD-fed mice challenged by ovalbumin (OVA). Collectively, our findings demonstrated a role of CD38 signaling pathway on the AHR of obesity and might be a potential therapeutic target for treating difficult-to-control obese asthma phenotype.

Association Between Airway Parameters and Abdominal Fat Measured via Computed Tomography in Asthmatic Patients

Purpose

We aimed to investigate whether airway parameters, assessed via computed tomography (CT), are associated with abdominal fat areas and to compare the clinical characteristics of asthmatic patients with and without elevated visceral to subcutaneous fat area ratio (EV).

Methods

Asthmatic patients (aged ≥40 years) were prospectively recruited. Chest (airway) and fat areas were assessed via CT. Airway parameters, including bronchial wall thickness (WT), lumen diameter (LD), lumen area (LA), wall area (WA), total area (TA), as well as WA/TA percentage (wall area %) were measured at the apical segmental bronchus in the right upper lobe. Visceral (VFA), subcutaneous (SFA) and total (TFA) fat areas (cm²) were also measured. The correlations between abdominal fat areas and airway parameters were assessed. EV was defined as VFA/SFA ≥ 0.4.

Results

Fifty asthmatic patients were included (mean age 62.9 years; 52% female); 38% had severe asthma. Significant correlations were found between VFA and both LD and LA (r = −0.35, P = 0.01; r = −0.34, P = 0.02, respectively), and SFA and both WA and TA (r = 0.38, P = 0.007; r = 0.34, P = 0.02, respectively). Exacerbations, requiring corticosteroid therapy or ER visitation, were significantly more frequent in subjects without EV (83% vs. 34%, P = 0.05).

Conclusions

Abdominal fat is associated with asthma, according to the location of fat accumulation. In asthmatic subjects, visceral fat seems to be attributable to the bronchial luminal narrowing, while subcutaneous fat may be related to thickening of bronchial wall.

Estimating the causal effect of body mass index on hay fever, asthma and lung function using Mendelian randomization

BACKGROUND

Observational studies have shown that body mass index (BMI) is positively associated with asthma. However, observational data are prone to confounding and reverse causation. In Mendelian randomization, genetic variants are used as unconfounded markers of exposures to examine causal effects. We examined the causal effect of BMI on asthma, hay fever, allergic sensitization, serum total immunoglobulin E (IgE), forced expiratory volume in one-second (FEV1) and forced vital capacity (FVC).

METHODS

We included 490 497 participants in the observational and 162 124 participants in the genetic analyses. A genetic risk score (GRS) was created using 26 BMI-associated single nucleotide polymorphisms (SNPs). Results were pooled in meta-analyses and expressed as odds ratios (ORs) or β-estimates with 95% confidence interval (CI).

RESULTS

The GRS was significantly associated with asthma (OR=1.009; 95% CI: 1.004, 1.013), but not with hay fever (OR= 0.998; 95% CI: 0.994, 1.002) or allergic sensitization (OR=0.999; 95% CI: 0.986, 1.012) per BMI-increasing allele. The GRS was significantly associated with decrease in FEV1: β=-0.0012 (95% CI: -0.0019, -0.0006) and FVC: β=-0.0022 (95% CI: -0.0031, -0.0014) per BMI-increasing allele. Effect sizes estimated by instrumental variable analyses were OR=1.07 (95% CI: 1.03, 1.10) for asthma, a 9 ml decrease in FEV1 (95% CI: 2.0-15 mL decrease) and a 16 ml decrease in FVC (95% CI: 7.0-24 mL decrease) per 1 kg/m² higher BMI.

CONCLUSIONS

The results support the conclusion that increasing BMI is causally related to higher prevalence of asthma and decreased lung function, but not with hay fever or biomarkers of allergy.

Biomarkers of airway and systemic inflammation in obese asthmatic paediatric patients

BACKGROUND

It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment.

OBJECTIVE

This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation.

METHODS

The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n=43), obese non-asthmatic (n=45), and non-obese non-asthmatic (control group, n=30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups.

RESULTS

No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9.

CONCLUSION

This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children.

Dynamic hyperinflation and exercise limitations in obese asthmatic women

Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35-39.9 kg/m²; n=36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m²; n=18] asthmatic patients performed a cardiopulmonary test to quantify peak V̇o₂ and a submaximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G (n = 36) presented higher peak V̇o₂ values but lower power-to-weight ratio values than the NOb-G (P <0 .05). DH was more common in the Ob-G (72.2%) than in the NOb-G (38.9%, P < 0.05). The Ob-G had a greater reduction in the inspiratory capacity (-18 vs. -4.6%, P < 0.05). Exercise tolerance was associated with quadriceps endurance (r = 0.65; p<0.001), oxygen pulse (r = 0.52; p=0.001), and DH (r = -0.46, P = 0.005). The multiple regression analysis showed that the exercise tolerance could be predicted from a linear association only for muscular endurance (r = 0.82 and r² = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients.NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O₂ pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.

Serum levels of adiponectin and leptin in asthmatic patients and its relation with asthma severity, lung function and BMI

INTRODUCTION

Asthma is one of the diseases which has a high prevalence in developed and developing countries. The relationship between asthma and obesity has always been focused by researchers. In this field, adipokines, especially adiponectin and leptin have highly attended by the scientist. The aim of this study was to determine the serum level of adiponectin, leptin and the leptin/adiponectin ratio in asthmatic patients and its relationship with disease severity, lung function and BMI (body mass index).

METHODS

In this cross-sectional study, 90 asthmatic women admitted to the tertiary referral hospital in Kurdistan province - Iran, were examined. First, BMI was measured and then pulmonary function tests were performed in all asthmatics patient. Forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and FEV1/FVC, were measured. At the end, blood samples were collected and serum level of adiponectin and leptin were measured by ELISA method.

RESULT

Serum leptin and leptin/adiponectin levels correlated positively with asthma severity and BMI (p=0.0001), but there was no correlation between adiponectin level with asthma severity and BMI (p>0.05), also serum leptin and leptin/adiponectin levels inversely correlated with FEV1 and FVC in patient (p=0.0001).

CONCLUSION

Asthma is linked with obesity, and there is an association between asthma severity and BMI with serum leptin and leptin/adiponectin levels, but our results do not support a significant role of adiponectin in obesity or asthma.

An obesity-preventive lifestyle score is negatively associated with pediatric asthma

PURPOSE

Lifestyle (diet and physical activity) may increase asthma risk, but evidence in this area is lacking. The aims of the present study were to calculate an obesity-preventive lifestyle score comprising of eating and physical activity behaviors and investigate the overall effect of lifestyle on asthma in children.

METHODS

A cross-sectional case-control study was carried out in 514 children (217 asthma cases and 297 healthy controls). Data were collected on medical history, anthropometry, dietary intake, and physical activity. We constructed an overweight/obesity-preventive score (OPLS) using study-specific quartile rankings for nine target lifestyle behaviors that were either favorable or unfavorable in preventing obesity (i.e., screen time was an unfavorable lifestyle behavior). The score was developed using the recommendations of the Expert Committee of American Academy of Pediatrics. Score values ranged from 0-18 points; the higher the score, the more protective against high body weight.

RESULTS

The OPLS was negatively associated with obesity indices (BMI, waist circumference, and hip circumference), (p < 0.05). Control children had a higher score when compared to asthma cases (9.3 ± 2.7 vs. 8.6 ± 2.9, p = 0.007). A high OPLS was protective against physician-diagnosed asthma (OR 0.92; 95% CI 0.86-0.98, p = 0.014), adjusted for several confounders. The OPLS was no longer protective after adjustment for BMI.

CONCLUSION

Higher adherence to an obesity-preventive lifestyle score-consistent with several behaviors for the prevention of childhood overweight/obesity-is negatively associated with obesity indices and lowers the odds for asthma in children. Lifestyle behaviors that contribute to a higher body weight may contribute to the obesity-asthma link. These findings are hypothesis-generating and warrant further investigation in prospective intervention studies.

Rapid adiposity growth increases risks of new-onset asthma and airway inflammation in children

BACKGROUND/OBJECTIVES

We aim to (1) examine the influence of long-term adiposity status/short-term adiposity changes on asthma with high or low fractional exhaled nitric oxide (Fe_NO), and (2) to determine the differences in long-term adiposity status/short-term adiposity changes on atopy, airway inflammation and pulmonary function.

SUBJECTS/METHODS

We recruited 2450 fourth- to sixth-grade children from the nationwide Taiwan Children Health Study. Data regarding various adiposity indicators, atopic status, pulmonary function tests and asthma outcomes were collected annually. New-onset asthma was stratified by airway inflammation status using Fe_NO. The generalized estimating equation was used for analyzing longitudinal relationships between long-term adiposity status/short-term adiposity changes and new-onset asthma. Individual adiposity growth slopes were obtained using a hierarchical linear model to establish the relationships between short-term adiposity changes and asthma among children with high airway inflammation.

RESULTS

We found long-term adiposity status predicted childhood asthma with low Fe_NO, whereas short-term adiposity changes may increase risks of childhood asthma with high Fe_NO. Long-term adiposity status reduced pulmonary function, whereas short-term adiposity increase were associated with atopic diseases and airway inflammation.

CONCLUSIONS

Obesity-induced asthma could be mediated by high or low airway inflammation, depending on the velocity of increase in adiposity. Rapid adiposity growth may increase risks of childhood asthma and airway inflammation.

Sex hormones and systemic inflammation are modulators of the obese-asthma phenotype

BACKGROUND

Both systemic inflammation and sex hormones have been proposed as potential mediators of the obese-asthma phenotype. The aim of this study was to examine the associations between sex hormones, oral contraceptive pill (OCP) use, systemic inflammation and airway inflammation in adults with asthma.

METHODS

Obese (n = 39) and nonobese (n = 42) females and obese (n = 24) and nonobese (n = 25) males with asthma were recruited. Females were further categorized as reproductive-aged (<50 years old; n = 36) or older (>50 years old; n = 45). Thirteen (36.1%) reproductive-aged females were using the OCP. Participants had induced sputum cell counts measured and blood analysed for sex hormones and inflammatory markers.

RESULTS

Obese reproductive-aged females had higher sputum %neutrophils than nonobese reproductive-aged females (45.4 ± 24.3% vs 27.5 ± 17.5%, P = 0.016); however, there was no difference in sputum neutrophils in obese compared with nonobese males (P = 0.620) or older females (P = 0.087). Multiple linear regression analysis found testosterone and OCP use to be negative predictors of sputum %neutrophils, while C-reactive protein and IL-6 were positive predictors of sputum %neutrophils. BMI and age were not significant predictors in the multivariate model. Reproductive-aged females using the OCP had significantly lower sputum %neutrophils than those not using the OCP (23.2 ± 12.6% vs 42.1 ± 23.8%, P = 0.015).

CONCLUSIONS

This study suggests that sex hormones and systemic inflammation may be mediating the obese-asthma phenotype. The observation that OCP use was associated with lower sputum %neutrophils in reproductive-aged females warrants further investigation.

Relationship Between Obesity and Asthma Control in Children Aged 4-18 years

OBJECTIVE

To analyze the relationship between obesity and asthma control in a group of patients with asthma.

METHODS

In this prospective study, body mass index (BMI) values of 200 asthma patients aged 4-18 y who had been regularly followed up by Kartal Education and Research Hospital Pediatric Asthma Outpatient Clinic were calculated. Asthma control test (ACT) and asthma control questionnaire (ACQ) were performed. The degrees of asthma control were evaluated with regard to BMI values in consideration of the data obtained.

RESULTS

The lowest and the highest BMI values were 12.4 and 30.0 kg/m(2), respectively (mean 18.1 ± 2.9). Of the total 200 children, 110 were boys and 90 were girls. It was found that 17 % of the patients were overweight and 16 % obese. ACT results showed that 72 patients had controlled asthma, 102 patients had partially controlled asthma and 26 patients had uncontrolled asthma. According to ACQ results, 165 patients had controlled asthma, 17 patients had partially controlled asthma and 18 patients had uncontrolled asthma.

CONCLUSIONS

Thus, it was found that there was no statistically significant difference between asthma control degrees of obese and non-obese patients. In other words, obesity did not affect the asthma control level.

The Effect of Body Mass Index on Spirometric Parameters in Children with Asthma

Aim:

Asthma and obesity represent one of the most crucial public and health problems of modern society that frequently begin in childhood and have some mutual elements of risk. Abdominal distribution of connective tissue is important determinant which brings to decrease of lungs function. Multiple influence of overweight on function of the lungs would clearly manifest over reduction of forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC).

Method:

Examining was conducted at Pediatric Clinic of University Clinical Hospital Tuzla during the year 2013/2014. Research included 60 children with diagnosed asthma who were in relation to BMI were divided in 3 groups. The first group was children with BMI ranging from 5 to 85 percentile, the second were children with 85 to 95 percentile and the third was 95 percentile. By prospective study, compared identical pulmonary variable for all three age group of asthma patients were analyzed, the children with normal body mass a well as the overweight and the obese.

Results:

At the beginning of testing, the frequency of normal spirometric findings was significantly lower in the obese group in comparison with other two observed groups (p<0,05). The only cases of mixed and restrictive disorder of ventilation were registered in the obese group of tested at the beginning of the examined (p<r0,001).

Conclusion:

When being compared the values of spirometric parameters before and after the research, the only significant difference was in the obese group, the values after tests were significantly higher, with the exception of relation FEV1/FVC, that had the same distribution of values before and after research. However, the group with normal body mass and overweight, had all the spirometric parameters with equal distribution before and after research (p>0,05 for all measurements).

An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Asthma is the most common pediatric chronic disease and is characterized by lung inflammation. Fractional exhaled nitric oxide (FeNO) is thought to reflect the presence of eosinophilic airway inflammation, and is an easy, non-invasive test that has held promise in providing additional objective data. However, not all studies have shown a clinical benefit in the use of FeNO to guide management of asthma in children. This review will describe the results of the most recent studies examining the use of FeNO in the diagnosis and treatment of asthma in infants, preschool-aged children and in school-aged children. It will aid the clinician in providing a clinical context in which FeNO may be most useful in treating pediatric asthma.

Considerations for Defining Cytokine Dose, Duration, and Milieu That Are Appropriate for Modeling Chronic Low-Grade Inflammation in Type 2 Diabetes

Proinflammatory cytokines have been implicated in the pathophysiology of both type 1 diabetes (T1D) and type 2 diabetes (T2D). T1D is an autoimmune disease involving the adaptive immune system responding to pancreatic beta-cells as antigen-presenting cells. This attracts immune cells that surround pancreatic islets (insulitis) and secrete cytokines, such as IL-1beta, IFN-gamma, and TNF-alpha, in close proximity to pancreatic beta-cells. In contrast, there is little evidence for such a focused autoimmune response in T2D. Instead, the innate immune system, which responds to cellular damage and pathogens, appears to play a key role. There are three major sources of proinflammatory cytokines that may impact islet/beta-cell function in T2D: (1) from islet cells, (2) from increased numbers of intraislet macrophages/immune cells, and (3) from increased circulating levels of proinflammatory cytokines due to obesity, presumably coming from inflamed adipose tissue. These differences between T1D and T2D are reflected by significant differences in the cytokine concentration, duration, and milieu. This review focuses on chronic versus acute cytokine action, cytokine concentrations, and cytokine milieu from the perspective of the pancreatic islet in T2D. We conclude that new cytokine models may be needed to reflect the pathophysiology of T2D more effectively than what are currently employed.