Mechanisms of Asthma in Obesity. Pleiotropic Aspects of Obesity Produce Distinct Asthma Phenotypes
- 1 May 2016
- journal article
- review article
- Published by American Thoracic Society in American Journal of Respiratory Cell and Molecular Biology
- Vol. 54 (5), 601-608
- https://doi.org/10.1165/rcmb.2016-0017ps
Abstract
The majority of patients with severe or difficult-to-control asthma in the United States are obese. Epidemiological studies have clearly established that obese patients tend to have worse asthma control and increased hospitalizations and do not respond to standard controller therapy as well as lean patients with asthma. Less clear are the mechanistic underpinnings for the striking clinical differences between lean and obese patients with asthma. Because obesity is principally a disorder of metabolism and energy regulation, processes fundamental to the function of every cell and system within the body, it is not surprising that it affects the respiratory system; it is perhaps surprising that it has taken so long to appreciate how dysfunctional metabolism and energy regulation lead to severe airway disease. Although early investigations focused on identifying a common factor in obesity that could promote airway disease, an appreciation has emerged that the asthma of obesity is a manifestation of multiple anomalies related to obesity affecting all the different pathways that cause asthma, and likely also to de novo airway dysfunction. Consequently, all the phenotypes of asthma currently recognized in lean patients (which are profoundly modified by obesity), as well as those unique to one’s obesity endotype, likely contribute to obese asthma in a particular individual. This perspective reviews what we have learned from clinical studies and animal models about the phenotypes of asthma in obesity, which show how specific aspects of obesity and altered metabolism might lead to de novo airway disease and profoundly modify existing airway disease.Keywords
This publication has 82 references indexed in Scilit:
- Body mass index correlates with pollutant-induced interleukin-1β in sputum and bloodAnnals of Allergy, Asthma & Immunology, 2014
- Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesisNature Medicine, 2014
- High-fat diet promotes lung fibrosis and attenuates airway eosinophilia after exposure to cockroach allergen in mice.Experimental Lung Research, 2013
- Predictors of response to tiotropium versus salmeterol in asthmatic adultsJournal of Allergy and Clinical Immunology, 2013
- Interleukin-1 Receptor and Caspase-1 Are Required for the Th17 Response in Nitrogen Dioxide–Promoted Allergic Airway DiseaseAmerican Journal of Respiratory Cell and Molecular Biology, 2013
- A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthmaJournal of Allergy and Clinical Immunology, 2011
- High‐fat feeding redirects cytokine responses and decreases allergic airway eosinophiliaClinical and Experimental Allergy, 2009
- Nuclear Factor-κB Activation in Airway Epithelium Induces Inflammation and HyperresponsivenessAmerican Journal of Respiratory and Critical Care Medicine, 2008
- Airway inflammation in obese and nonobese patients with difficult‐to‐treat asthmaAllergy, 2008
- Differential effects of ozone on airway and tissue mechanics in obese miceJournal of Applied Physiology, 2004