A Practical Approach to Assist Asthmatics to Lose Weight

Treating patients with obesity, particularly asthmatics, is a complex challenge that requires a unique and individually tailored approach. Obesity, defined by the Centers for Disease Control and Prevention, is a body mass index of 30.0 kg/m² or greater. It affects approximately 43% of adults and 19% of youth in America. It is a multifactorial disease and should be managed with the same intensity as any other medical problem, for it represents a risk factor for the onset and severity of asthma. Furthermore, it is a comorbid condition that exacerbates rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea, hypertension, anxiety, and depression. Being obese also increases morbidity for cardio/cerebrovascular diseases, metabolic syndrome, type 2 diabetes, breast and bladder cancer, and migraines. Osteoarthritis, in particular, of the knees and hips, is also associated with obesity, and that too will complicate asthma by hindering a subject's mobility and ability to exercise. This paper reviews the epidemiology and pathophysiology of obesity, its effect on asthma, and practical strategies to achieve weight loss.

Inhaled corticosteroid-phobia and childhood asthma: Current understanding and management implications

Asthma is the most prevalent chronic disease in children. Inhaled corticosteroids (ICS) is the first-line controller therapy for children with persistent asthma, however, suboptimal compliance to ICS therapy remains as a major obstacle in paediatric asthma management. Steroid-phobia, the fear of side-effects and subsequent aversion of ICS, has been widely reported in parents of asthmatic children. The reported prevalence of steroid-phobia varies widely from 19% to 67% in different populations. The concerns about ICS frequently raised by parents include growth suppression, weight gain, bone weakness, addiction and psychiatric disturbances. Outside of growth suppression, which is statistically significant yet mild in clinical studies, the other concerns are not evidence-based and are misconceptions. Conflicting results have been reported regarding the impact of steroid-phobia on ICS compliance. In contrast, steroid-phobia has consistent and negative effects on asthma control in children. While asthma educational programmes have demonstrable benefits in general paediatric populations, the generalisability of such programmes to steroid-phobic parents remains undetermined. There is a paucity of data on specific educational programmes to clear misconceptions and reduce steroid-phobia. Given the continually raising prevalence of paediatric asthma, high-quality studies are warranted to investigate the prevalence and impact of steroid-phobia, with an ultimate goal of developing effective strategies to tackle steroid-phobia and improve asthma care in children.

Oral corticosteroid-dependent asthma: current knowledge and future needs

PURPOSE OF REVIEW

To discuss the current use of oral corticosteroids (OCS) as a chronic treatment in patients with severe asthma and as a rescue treatment for patients presenting with acute exacerbations.

RECENT FINDINGS

Airways disease is responsible for the bulk of OCS use in the community and considerable OCS-associated morbidity. I speculate that the key mechanism leading to a beneficial effect in these situations is depletion of circulating eosinophils resulting in a reduced response to potentially inhaled corticosteroid unresponsive recruitment signals to the airway mucosa. This effect is shared by anti-IL-5 biological agents, which have emerged as highly effective OCS-sparing agents. Mitigation of the adverse effects of OCS might also result from a better appreciation of features associated with a response to OCS and targeted, biomarker-directed use.

SUMMARY

Longer term, there are real prospects that chronic and acute OCS use in asthma will be replaced by biological agents targeting eosinophilic airway inflammation more specifically and safely.