Obesity and Its Relationship with Asthma Prevalence and Severity in Adolescents from Southern Brazil

Obesity has been pointed out as a risk factor for higher prevalence of asthma and asthma-related symptoms in adolescents. The objective was to evaluate the relationship between the prevalence of asthma and obesity in adolescents living in Santa Maria and surroundings (state of Rio Grande do Sul, southern Brazil), applying the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. A total of 4,010 of 6,123 schoolchildren, 13 to 14 years of age, enrolled in the ISAAC phase III protocol (asthma core questionnaire) and were nutritionally evaluated: height, weight, and triceps skinfold (TSF) measurements. Prevalence of asthma (wheeze in the last 12 months) and prevalence of severe asthma (two or more affirmative responses to: more than 4 acute attacks of asthma, speech disturbance, sleep disturbance, wheezing with exercise) were evaluated and compared according to their nutritional status: obese and non-obese. Obese adolescents were defined by body mass index (BMI, in kg/m²) ≥85th percentile and TSF ≥85th percentile. Obese and non-obese groups were compared for prevalence of asthma and asthma severity using the Chi-square test and odds ratio (OR) with 95% confidence interval. Analyzing all adolescents, we observed a significant positive relationship between the prevalence of obesity and affirmative responses to “wheeze ever” (OR = 1.28; 95% CI 1.08-1.52), “wheezing with exercise” (OR = 1.36; 95% CI 1.11-1.66), “asthma ever” (OR = 1.29; 95% CI 1.03-1.62), and severe asthma (OR = 1.55; 95% CI 1.12-2.14). Among the boys, there was a significant positive association between obesity and “wheeze ever” (OR = 1.49; 95% CI 1.13-1.86). In girls, there was a significant positive relationship with “asthma ever” (OR = 1.38; 95% CI 1.01-1.88) and “wheezing with exercise” (OR = 1.36; 95% CI 1.11-1.66). This cross-sectional study with adolescents living in the southern region of Brazil showed that there is a positive association between obesity and prevalence of asthma symptoms and asthma severity, a finding mainly confined to girls.     

Obesity and Its Relationship with Asthma Prevalence and Severity in Adolescents from Southern Brazil

Obesity has been pointed out as a risk factor for higher prevalence of asthma and asthma-related symptoms in adolescents. The objective was to evaluate the relationship between the prevalence of asthma and obesity in adolescents living in Santa Maria and surroundings (state of Rio Grande do Sul, southern Brazil), applying the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. A total of 4,010 of 6,123 schoolchildren, 13 to 14 years of age, enrolled in the ISAAC phase III protocol (asthma core questionnaire) and were nutritionally evaluated: height, weight, and triceps skinfold (TSF) measurements. Prevalence of asthma (wheeze in the last 12 months) and prevalence of severe asthma (two or more affirmative responses to: more than 4 acute attacks of asthma, speech disturbance, sleep disturbance, wheezing with exercise) were evaluated and compared according to their nutritional status: obese and non-obese. Obese adolescents were defined by body mass index (BMI, in kg/m²) ≥85th percentile and TSF ≥85th percentile. Obese and non-obese groups were compared for prevalence of asthma and asthma severity using the Chi-square test and odds ratio (OR) with 95% confidence interval. Analyzing all adolescents, we observed a significant positive relationship between the prevalence of obesity and affirmative responses to “wheeze ever” (OR = 1.28; 95% CI 1.08–1.52), “wheezing with exercise” (OR = 1.36; 95% CI 1.11–1.66), “asthma ever” (OR = 1.29; 95% CI 1.03–1.62), and severe asthma (OR = 1.55; 95% CI 1.12–2.14). Among the boys, there was a significant positive association between obesity and “wheeze ever” (OR = 1.49; 95% CI 1.13–1.86). In girls, there was a significant positive relationship with “asthma ever” (OR = 1.38; 95% CI 1.01–1.88) and “wheezing with exercise” (OR = 1.36; 95% CI 1.11–1.66). This cross-sectional study with adolescents living in the southern region of Brazil showed that there is a positive association between obesity and prevalence of asthma symptoms and asthma severity, a finding mainly confined to girls.     

Obesity Is Associated with Bronchial Hyper-Responsiveness in Women

The study's objective was to compare the bronchial hyper-responsiveness (BHR) between those with normal and increased weight and evaluate if the association was sex-specific. In this cross-sectional review of methacholine challenge test results of 1,141 adults for evaluation of respiratory symptoms, logistic regression analysis was conducted to adjust for covariates. When compared to normal weight, overweight or obese women showed a higher prevalence of symptomatic BHR with odds ratios of 1.63 (95% C.I. 1.16-2.29). This association was not seen in men, with a significant sex-specific interaction. This study shows a sex-specific association between symptomatic BHR and overweight or obese status.     

Obesity Is Associated with Bronchial Hyper-Responsiveness in Women

The study's objective was to compare the bronchial hyper-responsiveness (BHR) between those with normal and increased weight and evaluate if the association was sex-specific. In this cross-sectional review of methacholine challenge test results of 1,141 adults for evaluation of respiratory symptoms, logistic regression analysis was conducted to adjust for covariates. When compared to normal weight, overweight or obese women showed a higher prevalence of symptomatic BHR with odds ratios of 1.63 (95% C.I. 1.16–2.29). This association was not seen in men, with a significant sex-specific interaction. This study shows a sex-specific association between symptomatic BHR and overweight or obese status.     

The number and function of T regulatory cells in obese atopic female asthmatics

Background: Mechanisms underlying the association between asthma and obesity remain poorly understood. Obesity appears to be a risk factor for asthma, and obese asthmatics fare poorly compared to lean asthmatics. Objectives: To explore the possibility that reduced regulatory T cell (Treg) number and function contribute to the obesity-asthma association. We concentrated on obese females with childhood-onset asthma, since Treg may be involved in this phenotype. Methods: We recruited 64 women (ages 18–50) into four groups: lean (BMI 18–25 kg/m²) controls (n = 17) and asthmatics (n = 13), and obese (BMI ≥ 35 kg/m²) controls (n = 17) and asthmatics (n = 17). Asthmatics had atopy and childhood-diagnosed asthma. We assessed lung function, asthma control and quality of life. Peripheral blood CD4+/CD25+/FoxP3+ Treg cells were identified and counted by flow cytometry and expressed as % total CD4+ T cells. We assessed Treg cell function by the ability of CD4+/CD25+ Treg cells to suppress autologous CD4+/CD25- responder T cell (Tresp) proliferation and measured as % suppression of Tresp cell proliferation. Results: Obese asthmatics had worse lung function, asthma control, and quality of life compared to lean asthmatics. Compared to lean or obese control groups, the number of Treg cells in the obese asthmatics was approximately 1.58- or 1.73-fold higher. The ability of Treg cells from obese-asthmatics to suppress Tresp cell proliferation was reduced. Conclusions: Obese, atopic women with childhood diagnosed asthma demonstrate increased Treg cell number and mildly decreased Treg cell function. Our data do not support the view that reduced Treg cell number contributes to this obese-asthma phenotype.     

The Effect of Bariatric Surgery in the Difficult Asthma–Obesity Phenotype: A Case Report

Introduction. Obesity and asthma have become increasingly prevalent conditions in recent years; they often coexist and place a significant burden on the National Health Service. Asthma in the obese is more difficult to treat than in those with a normal body mass index (BMI) and is associated with resistance to traditional asthma therapies and increased use of healthcare resources. Weight loss can improve asthma control in such patients. The degree of weight loss achieved through dietary strategies, however, is often only modestly successful in this group. Bariatric surgery is increasingly used to achieve sustained significant weight loss in morbid obesity. It may offer under-recognized benefit in the difficult asthma–obesity phenotype. Case study. We describe the case of a 32-year-old female with difficult asthma who had a BMI of 45 kg/m² at the time of referral to our clinic. Her asthma was uncontrolled despite maximal inhaled therapy, oral therapy with Zafirlukast, and daily high-dose (25 mg) oral prednisolone. Additional therapies (subcutaneous Terbutaline and the steroid-sparing agent Methotrexate) had little impact on asthma control and she remained morbidly obese. She underwent gastric bypass surgery and, over the following 18 months, her BMI dropped to 27.7 kg/m², her corticosteroid dose was reduced to 7.5 mg (adrenal insufficiency proven), and maintenance inhaled therapy and oral medications were stopped as she maintained good asthma control. Conclusion. This case demonstrates the dramatic improvement that bariatric surgery can have on asthma symptoms and medication use in morbidly obese patients with very difficult to control asthma.     

Independent and Synergistic Associations of Asthma and Obesity with Systemic Inflammation in Adolescents

Introduction. Both asthma and obesity often occur in the same individual. Each increases the risk of cardiovascular disease (CVD) with systemic inflammation likely playing a vital role. We examined the independent and synergistic associations of asthma and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP) levels in adolescents. Methods. This study involves the cross-sectional design carried out in the adolescent and respiratory medicine practices in a children’s hospital. Out of 124 adolescents (mean age 16.1 ± 2.3 years), who were either of obese (N = 75) or of normal weight (N = 49). 51 had asthma (18 normal weight and 33 obese). Results. hs-CRP levels were higher in obese versus normal weight groups (geometric mean ± SD: 2.38 ± 2.91 vs. 0.72 ± 3.54; p < .001), and in the asthmatic versus non-asthmatic groups (geometric mean ± SD: 1.21 ± 3.71 vs.1.96 ± 3.28; p = .039). We found a trend of increasing hs-CRP levels across the four groups (p < .001), with the obese asthmatic group having the highest level. In multivariate regression, we found a strong association between obesity and log-CRP (β ± SE: 1.43 ± 0.23; p < .001) and a moderate association between asthma and log-CRP (β ± SE: 0.48 ± 0.21; p < .028), with additive synergy between obesity and asthma. Conclusions. Both asthma and obesity are independently and synergistically associated with systemic inflammation. These findings underline the need of a multifaceted approach to address CVD risk in adolescence.     

Effect of Obesity on Clinical Presentation and Response to Treatment in Asthma

Obesity is a risk factor for being diagnosed with asthma, but there is conflicting evidence on whether obesity is a risk factor for lung function abnormalities characteristic of asthma. We studied a cohort of 488 subjects, 47% of whom were obese. Obese and non-obese subjects with asthma had similar airflow limitation and bronchodilator responsiveness, but obese participants had increased sleep disturbance and gastroesophageal reflux disease, higher cytokine levels, and a trend towards increased exacerbations when treated with theophylline. Obese and non-obese asthmatics have similar lung function abnormalities, but comorbidities and altered responses to medications may significantly affect asthma control in obese people.     

Effect of Obesity on Clinical Presentation and Response to Treatment in Asthma

Obesity is a risk factor for being diagnosed with asthma, but there is conflicting evidence on whether obesity is a risk factor for lung function abnormalities characteristic of asthma. We studied a cohort of 488 subjects, 47% of whom were obese. Obese and non-obese subjects with asthma had similar airflow limitation and bronchodilator responsiveness, but obese participants had increased sleep disturbance and gastroesophageal reflux disease, higher cytokine levels, and a trend towards increased exacerbations when treated with theophylline. Obese and non-obese asthmatics have similar lung function abnormalities, but comorbidities and altered responses to medications may significantly affect asthma control in obese people.     

Association between Obesity and Asthma in US Children and Adolescents

Background. To explore the association between obesity and asthma in US children and adolescents with adjustment of other structural and behavioral factors. Method. Prevalence and associated risk factors of asthma were explored in 102,273 children and adolescents in the National Survey of Children's Health (2003–2004). Subgroup analysis was performed for subjects of 0-6 year-old, 7–12 year-old, and 13–17 year-old. Crude and adjusted odds ratios for the potential risk factors were examined in univariate and multivariate logistic regressions. Results. The overall prevalence of obesity was 24.5% and that of asthma was 12.5%. The adjusted odds ratio of asthma with obesity remains significantly bigger than 1 for children in the 7–12 and the 13–17 year-old age-groups. Gender and race were significantly associated with asthma in all age groups. The two parent family structure showed significant protectiveness against asthma with children in the 0–6 year-old age group. Poverty was positively associated with asthma in the 7–12 years old age group. Having a smoker in the household increased the odds of asthma by 29% and 23.5% in the 0–6 and 13–17 year-old age-groups, respectively. Higher education level of the parents and access to healthcare showed positive association with asthma in the 13–17 year-old age group. Conclusion. Gender and race were significantly associated with asthma. In the 13–17 year-old age-groups, obesity, household education level, healthcare coverage, and household smoking were positively associated with asthma. Further studies should characterize how the family structure and household education level influence childhood asthma in 0–6 and 13–17 year-old age-groups respectively.     

Dynamics of eicosanoids in peripheral blood cells during bronchial provocation in aspirin-intolerant asthmatics.

The underlying mechanisms of bronchoconstriction in aspirin-intolerant asthmatics (AIAs) are still unknown, but the hypothesis of an altered metabolism of arachidonic acid is generally accepted. So far, no in vitro test for aspirin intolerance is available. The hypothesis that the profile of eicosanoid mediators is changed in AIA-even before aspirin challenge was tested. The release of prostaglandin E2 (PGE2), peptidoleukotrienes and histamine was measured using competitive enzyme immunoassays in 10 asthmatics with a history of aspirin intolerance, 10 controls and eight aspirin-tolerant asthmatics (ATAs) before and after bronchial provocation with lysine-aspirin. Comparing basal release of eicosanoids before challenge, peptidoleukotrienes were significantly elevated and PGE2 was vastly reduced in AIAs, whereas ATAs had elevated basal peptidoleukotrienes but only slightly reduced basal PGE2. The decrease in forced expiratory volume in one second (FEV1) was not associated with changes in histamine release. After aspirin challenge, there was a massive increase of already elevated peptidoleukotrienes in AIAs, but not in ATAs. Arachidonic acid-induced PGE2 release in AIAs was not significantly changed, whereas it was significantly reduced in ATAs and healthy controls. Histamine release was unaffected by aspirin challenge in all three groups. There is a typically altered profile of eicosanoids in aspirin-intolerant asthmatics which could make in vitro diagnosis of aspirin intolerance possible.     

Effects of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease on Asthma Control in Obesity

Background. Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. Objectives. The purpose of this study was to determine if (1) reflux and/or (2) symptoms of sleep apnea contribute to poor asthma control in obesity. Methods. We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. Overall 304 participants underwent esophageal pH probe testing; 246 participants were evaluated for obstructive sleep apnea symptoms. Results. Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control. Those with higher body mass index (BMI) reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control. Symptoms and self-report of obstructive sleep apnea were more common with increasing BMI and associated with worse asthma control as measured by the Juniper Asthma Control questionnaire and Asthma Symptom Utility Index. Conclusions. Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease, may contribute significantly to poor asthma control in obese patients.     

The Associations between Smoking, Physical Inactivity, Obesity, and Asthma Severity in the General US Population

The purpose of this study was to examine the associations between smoking, physical inactivity, obesity, and asthma severity among US adults. The magnitude of these associations was very strong. For example, those who visited an emergency room in the past year were 60% more likely than those who did not to smoke; those who used an inhaler ≥15 times in the past month (versus those who did not use an inhaler) were 90% more likely to be physically inactive; and those who had asthma symptoms all the time in the past 30 days (versus those with no symptoms) were 80% more likely to be obese.     

The Associations between Smoking,Physical Inactivity,Obesity, and Asthma Severity in the General US Population

The purpose of this study was to examine the associations between smoking, physical inactivity, obesity, and asthma severity among US adults. The magnitude of these associations was very strong. For example, those who visited an emergency room in the past year were 60% more likely than those who did not to smoke; those who used an inhaler ≥15 times in the past month (versus those who did not use an inhaler) were 90% more likely to be physically inactive; and those who had asthma symptoms all the time in the past 30 days (versus those with no symptoms) were 80% more likely to be obese.     

哮喘患者非急性发作期病情与用药情况调查

目的　了解目前哮喘患者的防治状况 ,进一步以提高哮喘患者的自我防治水平 ;方法　对 5 0 1位哮喘患者进行哮喘问卷调查和肺功能检查 ;结果　 5 0 1例中男性 2 70人 ,女性 2 31人 ;年龄 14～ 78岁 ,平均 4 6 .0 3± 12 .39岁。病程 3～ 6 0年 ,平均 31.4±11.1年。间歇发作、轻度、中度和重度患者分别占 9.0 %、19.0 %、38.7%和 33.3%。有 34.1%患者有哮喘家族史 ,有 6 0 .1%患者同时伴有其他过敏性疾病 (过敏性鼻炎 4 3.3% ,过敏性皮炎 35 .3% ) ,有 80 .0 %患者有明显的诱发因素 (呼吸道感染 39.1%、冷空气2 9.9%、吸入刺激性气体 37.9%、接触已知的过敏原 4 4 .9%、运动或劳累 2 4 .8%及其他 18.6 % )。 2 7.3%和 8.2 %患者在过去一年中曾有哮喘发作史。 83.2 %被调查者已了解吸入型糖皮质激素是目前最有效的预防哮喘的治疗措施 ,其中 32 1人正在接受吸入型糖皮质激素治疗 ,占被调查总人数的 6 4 .1% ,吸入皮质激素的有效率为 2 7.7%。吸入皮质激素的不良反应发生率为 8.7% ,主要表现在咽部不适 (2 .7% )、声嘶 (2 .6 % )、呛咳 (2 .0 % )和恶心 (1.4 % )。合并使用 β2 -受体激动剂、茶碱类药物和抗胆碱能药物的患者分别占 6 2 .1%、38.5 %和 15 .6 % ;合并使用酮替芬、抗白三烯药物和抗组胺药物的     

Obesity is not Associated with Mild Asthma Diagnosis in a Population of Spanish Adults

Background. Several studies have suggested a relationship between asthma and obesity. Moreover, atopy is an important risk factor for asthma, but the relationship between obesity and atopy is uncertain. Methods. A cross-sectional multicenter study was conducted in a population of Spanish adults between November 2007 and July 2008. The subjects included had experienced asthma symptoms in the last year but had a forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) > 70%. Mild asthma diagnosis was confirmed by measuring airway hyperresponsiveness to methacholine. Body mass index in kg/m² was used as measure of obesity. Subjects were considered atopic when they had at least one positive skin prick test to common aeroallergens. Adjusted odd ratios (OR) were obtained by logistic regression. Results. A total of 662 subjects were included and 234 subjects (35.3%) were diagnosed with asthma (consistent symptoms and positive methacholine test). After adjusting the model for age, gender, atopy, baseline FEV₁, and FEV₁/FVC ratio, there was no association between overweight or obesity with asthma diagnosis, with OR of 0.889 (95% CI, 0.60–1.38) and 0.925 (95% CI, 0.577–1.48), respectively. A multivariable logistic regression analysis confirmed that atopy increases the risk of asthma (p = 0.008). The non-atopic obese group had an increased risk of asthma compared to the non-atopic group with normal weight or overweight (p = 0.0032). Conclusions. In this study obesity was not associated with a diagnosis of asthma. The presence of atopy was a risk factor for asthma, independent of obesity. Obesity, however, may be a risk factor for the development of asthma among non-atopic subjects.