Obesity and Asthma - a separate chapter

Abstract

Asthma and obesity are two highly prevalent chronic inflammatory conditions that frequently coexist, with obese individuals presenting a significantly higher incidence of asthma compared to eutrophic counterparts. This association is bidirectional and demonstrates sexual dimorphism, with obese women showing higher asthma rates than obese men. The pathophysiology involves multiple overlapping mechanisms, including chronic systemic low-grade inflammation mediated by adipokines and pro-inflammatory cytokines (IL-6, TNF-α, leptin), T2-mediated inflammatory pathways, and mechanical factors related to reduced functional residual capacity. Obese asthmatics present more severe clinical manifestations, including lower baseline pulmonary function, increased exacerbation rates (50% higher than eutrophic patients), higher hospitalization rates (2-4 times greater), and greater susceptibility to respiratory infections. Additionally, they exhibit reduced responsiveness to standard asthma treatments, including short-acting beta-agonists, inhaled corticosteroids, and possibly biological therapies. Management of these patients requires a multifaceted approach encompassing weight loss (even 5% reduction improves asthma control), aerobic physical activity with anti-inflammatory effects independent of weight loss, dietary interventions rich in fruits and vegetables, and pharmacological options. Notably, GLP-1 receptor agonists have emerged as promising therapeutic agents, demonstrating benefits in asthma control and weight reduction in both diabetic and non-diabetic obese asthmatic patients, through mechanisms that may extend beyond weight loss alone. Bariatric surgery represents an option for patients failing lifestyle and medical interventions, showing significant reduction in asthma exacerbations. These emerging therapeutic approaches offer new perspectives for improved clinical control in this challenging patient population.