The Relationship of Obesity with Asthma Control and Airway Inflammatory Phenotype_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZhengJie , ZhangXin , ZhengJing ,  WangGang

Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China;

Corresponding author：

WangGang, Email: wong-gang@126.com

Keywords：

Obesity; Asthma control; Airway inflammatory phenotype

DOI：

10.7507/1671-6205.2015134

Video：

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Objective To explore the relationship of obesity with asthma control and airway inflammatory phenotype. Methods A cross-sectional prospective study was conducted on 101 patients with asthma. Asthma control level was assessed by Asthma Control Test (ACT) and GINA. Furthermore, height and weight were measured and body mass index (BMI) was calculated. Lung function and sputum induction were performed, and differential cell count was obtained from induced sputum and peripheral blood. Results Ninety eligible patients were divided into 3 groups as a normal-weight group (n=54), an over-weight group (n=21) and an obesity group (n=15). The asthma control levels were different among three groups (P=0.019 for ACT and P=0.014 for GINA, respectively). BMI was positively related to the number of neutrophils in induced sputum (r=0.29, P=0.039). Increased BMI deteriorated asthma control levels assessed by ACT[OR=1.84, 95% CI (1.04, 3.23), P=0.035] and GINA[OR=2.27, 95% CI (1.27, 4.07), P=0.006] in a dose-response manner. Obesity indicated poor asthma control assessed by ACT (P=0.015) and GINA (P=0.008) after adjusting for age, sex, duration of asthma, FEV₁%pred, smoking, and the number of neutrophils in peripheral blood. Conclusions In Chinese individuals with asthma, neutrophilic inflammatory phenotype dominates the airway inflammation of obesity-associated asthma. Obesity is a risk factor that deteriorates asthma control level in a significant dose-response manner.

Citation： ZhengJie, ZhangXin, ZhengJing, WangGang. The Relationship of Obesity with Asthma Control and Airway Inflammatory Phenotype. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(6): 546-552. doi: 10.7507/1671-6205.2015134 Copy

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13.	Zhou X, Ding FM, Lin JT, et al. Validity of Asthma Control Test in Chinese patients. Chin Med J (Engl),2007,20:1037-1041.
14.	Wei HH, Zhou T, Wang L, et al. Current asthma control predicts future risk of asthma exacerbation:a 12-month prospective cohort study. Chin Med J (Engl),2012,125:2986-2993.
15.	Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med,2007,175:661-666.
16.	Hasegawa K, Tsugawa Y, Lopez BL, et al. Body mass index and risk of hospitalization among adults presenting with asthma exacerbation to the emergency department. Ann Am Thorac Soc,2014,11:1439-1444.
17.	Douwes J, Gibson P, Pekkanen J, et al. Non-eosinophilic asthma:importance and possible mechanisms. Thorax,2002,57:643-648.
18.	Baines KJ, Simpson JL, Wood LG, et al. Transcriptional phenotypes of asthma defined by gene expression profiling of induced sputum samples. J Allergy Clin Immunol,2011,127:153-160.
19.	Diaz J, Farzan S. Clinical implications of the obese-asthma phenotypes. Immunol Allergy Clin North Am,2014,34:739-751.
20.	Sood A, Cui X, Qualls C, et al. Association between asthma and serum adiponectin concentration in women. Thorax,2008,63:877-882.
21.	丁念昌,邓星奇,周玲,等.哮喘患者脂联素水平的变化及意义.中国呼吸与危重监护杂志,2013,12:451-453.
22.	高俊杰,张为忠,纪霞,等.瘦素受体基因Gln223Arg位点多态性在哮喘发病中的作用.中国呼吸与危重监护杂志,2014,13:584-587.
23.	Scott HA, Gibson PG, Garg ML, et al. Airway inflammation is augmented by obesity and fatty acids in asthma. Eur Respir J,2011,38:594-602.
24.	李贱,邹朋成,杨莉容,等.Th17细胞在哮喘发病中的作用研究进展.中国呼吸与危重监护杂志,2013,12:322-324.
25.	van Veen IH, Ten Brinke A, Sterk PJ, et al. Airway inflammation in obese and nonobese patients with difficult-to-treat asthma. Allergy,2008,63:570-574.
26.	Todd DC, Armstrong S, D'Silva L, et al. Effect of obesity on airway inflammation:a cross-sectional analysis of body mass index and sputum cell counts. Clin Exp Allergy,2007,37:1049-1054.
27.	Telenga ED, Tideman SW, Kerstjens HA, et al. Obesity in asthma:more neutrophilic inflammation as a possible explanation for a reduced treatment response. Allergy,2012,67:1060-1068.
28.	Forno E, Lescher R, Strunk R, et al. Childhood Asthma Management Program Research Group. Decreased response to inhaled steroids in overweight and obese asthmatic children. J Allergy Clin Immunol,2011,127:741-749.
29.	Hulley SB, Cummings SR, Browner WS, et al. Designing clinical research. 4th Ed. Philadelphia:Lippincott Williams & Wikins,2013.

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Available from:www.ginasthma.org.[2015-04-17].
2. Sideleva O, Black K, Dixon AE. Effects of obesity and weight loss on airway physiology and inflammation in asthma. Pulm Pharmacol Ther,2013,26:455-458.
3. 毕鑫,霍建民.肥胖人群并发支气管哮喘的可能机制——氧化应激.中华哮喘杂志:电子版,2012,6:43-45.
4. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet,2014,384:766-781.
5. Friel S, Chopra M, Satcher D. Unequal weight:equity oriented policy responses to the global obesity epidemic. BMJ,2007,335:1241-1243.
6. 中华医学会呼吸病分会哮喘学组.中国支气管哮喘防治指南.中华结核和呼吸杂志,2008,31:177-185.
7. 中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防控制指南.北京:人民卫生出版社,2006,3.
8. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test:a survey for assessing asthma control. J Allergy Clin Immunol,2004,113:59-65.
9. Gibson PG, Wlodarczyk JW, Hensley MJ, et al. Epidemiological association of airway inflammation with asthma symptoms and airway hyperresponsiveness in childhood. Am J Respir Crit Care Med.1998,158:36-41.
10. Zhou X, Ding FM, Lin JT, et al. Validity of asthma control test for asthma control assessment in Chinese primary care settings. Chest,2009,135:904-910.
11. Jia CE, Zhang HP, Lv Y, et al. The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control:systematic review and meta-analysis. J Allergy Clin Immunol,2013,131:695-703.
12. Simpson JL, Scott R, Boyle MJ, et al. Inflammatory subtypes in asthma:assessment and identification using induced sputum. Respirology,2006,11:54-61.
13. Zhou X, Ding FM, Lin JT, et al. Validity of Asthma Control Test in Chinese patients. Chin Med J (Engl),2007,20:1037-1041.
14. Wei HH, Zhou T, Wang L, et al. Current asthma control predicts future risk of asthma exacerbation:a 12-month prospective cohort study. Chin Med J (Engl),2012,125:2986-2993.
15. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma:a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med,2007,175:661-666.
16. Hasegawa K, Tsugawa Y, Lopez BL, et al. Body mass index and risk of hospitalization among adults presenting with asthma exacerbation to the emergency department. Ann Am Thorac Soc,2014,11:1439-1444.
17. Douwes J, Gibson P, Pekkanen J, et al. Non-eosinophilic asthma:importance and possible mechanisms. Thorax,2002,57:643-648.
18. Baines KJ, Simpson JL, Wood LG, et al. Transcriptional phenotypes of asthma defined by gene expression profiling of induced sputum samples. J Allergy Clin Immunol,2011,127:153-160.
19. Diaz J, Farzan S. Clinical implications of the obese-asthma phenotypes. Immunol Allergy Clin North Am,2014,34:739-751.
20. Sood A, Cui X, Qualls C, et al. Association between asthma and serum adiponectin concentration in women. Thorax,2008,63:877-882.
21. 丁念昌,邓星奇,周玲,等.哮喘患者脂联素水平的变化及意义.中国呼吸与危重监护杂志,2013,12:451-453.
22. 高俊杰,张为忠,纪霞,等.瘦素受体基因Gln223Arg位点多态性在哮喘发病中的作用.中国呼吸与危重监护杂志,2014,13:584-587.
23. Scott HA, Gibson PG, Garg ML, et al. Airway inflammation is augmented by obesity and fatty acids in asthma. Eur Respir J,2011,38:594-602.
24. 李贱,邹朋成,杨莉容,等.Th17细胞在哮喘发病中的作用研究进展.中国呼吸与危重监护杂志,2013,12:322-324.
25. van Veen IH, Ten Brinke A, Sterk PJ, et al. Airway inflammation in obese and nonobese patients with difficult-to-treat asthma. Allergy,2008,63:570-574.
26. Todd DC, Armstrong S, D'Silva L, et al. Effect of obesity on airway inflammation:a cross-sectional analysis of body mass index and sputum cell counts. Clin Exp Allergy,2007,37:1049-1054.
27. Telenga ED, Tideman SW, Kerstjens HA, et al. Obesity in asthma:more neutrophilic inflammation as a possible explanation for a reduced treatment response. Allergy,2012,67:1060-1068.
28. Forno E, Lescher R, Strunk R, et al. Childhood Asthma Management Program Research Group. Decreased response to inhaled steroids in overweight and obese asthmatic children. J Allergy Clin Immunol,2011,127:741-749.
29. Hulley SB, Cummings SR, Browner WS, et al. Designing clinical research. 4th Ed. Philadelphia:Lippincott Williams & Wikins,2013.

Chinese Journal of Respiratory and Critical Care Medicine

The Relationship of Obesity with Asthma Control and Airway Inflammatory Phenotype

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