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OBESITY AND ASTHMAOBESITY AND ASTHMA
Dr. Enrico HefflerDr. Enrico Heffler ([email protected]) ([email protected])
MD, Specialist in Allergy and Clinical ImmunologyMD, Specialist in Allergy and Clinical Immunology
Allergy and Clinical Immunology - University of Torino (Italy)
Allergy Outpatients’ Clinic- “E.Agnelli” Hospital - Pinerolo (Italy)Allergy Outpatients’ Clinic- “E.Agnelli” Hospital - Pinerolo (Italy)
Allergy Outpatients’ Clinic – Valenza, Casale Monferrato and Allergy Outpatients’ Clinic – Valenza, Casale Monferrato and Acqui Terme Hospitals (Italy)Acqui Terme Hospitals (Italy)
OBESITY
DEFINITION:
* Excessive fat in body tissues.
* The National Heart, Lung and Blood Institute (NHLBI) defines
overweight as having a body mass index (BMI) of 25 to 29.9
and obese as having a BMI of 30 or greater.
OBESITY AS A RISK FACTOR:
* Obesity increases the risk of developing many health
conditions:
OBESITY
INCREASING PREVALENCE IN WESTERN COUNTRIES:
England
16-64 yrs.
USA
20-74 yrs.
Former E. Germany25-65 yrs.
W. Samoa (urban)
25-69 yrs.
Japan
20+ yrs.
Brazil
25-64 yrs.
1982 1987 1993 1975 1989 1980 1966 1991 1995 1973 1978 1991 1985 1989 1992 1978 1991
1982 1987 1993 1975 1989 1980 1966 1991 1995 1973 1978 1991 1985 1989 1992 1978 1991
- 80
- 70
- 60
- 50
- 40
- 30
- 20
- 10
- 0
- 80
- 70
- 60
- 50
- 40
- 30
- 20
- 10
- 0
Women
Men
Pre
vale
nce
of o
besi
ty (
%)
Pre
vale
nce
of o
besi
ty (
%)
OBESITY
INCREASING PREVALENCE IN WESTERN COUNTRIES:
USA 1990 – 2004:
OBESITY
INCREASING PREVALENCE IN WESTERN COUNTRIES:
UK 1987 – 2004:
OBESITY
INCREASING PREVALENCE IN WESTERN COUNTRIES:
OBESITY
ASTHMA
INCREASING PREVALENCE IN WESTERN COUNTRIES:
OBESITY & ASTHMA
EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:
* Studies have shown 1.5-3-0 fold increase in prevalence of
asthma amongst obese patients.
OBESITY & ASTHMA
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
OBESITY & ASTHMA
Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010
OBESITY & ASTHMA
EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:
* Studies have shown 1.5-3-0 fold increase in prevalence of
asthma amongst obese patients.
* Weight gain is associated with incident cases of asthma.
86.000 US registered nurses (age 26-46) who were free of asthma at the start of the study followed for 4 years. Analysis of 1596 new asthma diagnosis between 1991-95.
“ The Nurses Health Study “
OBESITY & ASTHMA
Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588
“ The Nurses Health Study “
OBESITY & ASTHMA
Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588
OBESITY & ASTHMA
Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010
OBESITY & ASTHMA
EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:
* Studies have shown 1.5-3-0 fold increase in prevalence of
asthma amongst obese patients.
* Weight gain is associated with incident cases of asthma.
* Weight loss is associated with improved asthma outcomes.
Stenius-Aarniala B et al. – Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000
OBESITY & ASTHMA
OBESITY & ASTHMA
EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA:
* Studies have shown 1.5-3-0 fold increase in prevalence of
asthma amongst obese patients.
* Weight gain is associated with incident cases of asthma.
* Weight loss is associated with improved asthma outcomes.
* There is particularly compelling association between obesity
and more severe asthma, particularly in females.
Distribution of BMI among adults presenting to the ED with acute asthma.
Thomson CC et al. Chest 2003;124:795-802
OBESITY & ASTHMA
OBESITY & ASTHMA
Thomsen SF et al. – Association between obesity and asthma in a twin cohort. Allergy 2007;62:1199-1204
Chen Y et al et al – The association between obesity and asthma is stronger in non-allergic than allergic adults. Chest 2006
OBESITY & ASTHMA
MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:
OBESITY & ASTHMA
MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:
OBESITY & ASTHMA
MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA:
OBESITY & ASTHMA
OBESITY & ASTHMA
Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008
Asthmatics Controls
RESPONSE TO INHALED CORTICOSTEROIDS:
OBESITY & ASTHMA
Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008
OBESITY & ASTHMA
Asthmatics Controls
Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008
RESPONSE TO INHALED CORTICOSTEROIDS:
* Obese patients with asthma seem to have a predominant
sputum neutrophilia (“noneosinophilic asthma”) associated
to more severe asthma
Reduced response to inhaled corticosteroids therapy?
* We retrospectively studied 42 patients with asthma who had
undergone assessment of airway function and inflammation
before and two months after treatment with inhale budesonide
400 mcg twice daily
(Green et al. - Analysis of induced sputum in adults with asthma. Thorax 2002; 57(10):875-879)
OBESITY & ASTHMA
Heffler E, Green RH, Brightling C and Pavord ID – submitted
PATIENTS & METHODS
PATIENTS:* 42 patients (23 males; 19 females) with asthma diagnosed in
accordance with the current international guidelinesSTUDY DESIGN:
* Potential predictive factors: BMI, age, gender, atopy, eosinophils
and neutrophils differential cell counts in induced sputum
* Response parameters: methacoline PC20FEV1, sputum eosinophils,
symptoms VAS and FEV1
Heffler E, Green RH, Brightling C and Pavord ID – submitted
RESULTS
THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:
Heffler E, Green RH, Brightling C and Pavord ID – submitted
RESULTS
THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:
Heffler E, Green RH, Brightling C and Pavord ID – submitted
RESULTS
THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI:
Heffler E, Green RH, Brightling C and Pavord ID – submitted
CONCLUSIONS
* Our data are in agreement with a paper by Peters-Golden et al.
(Eur Resp J 2006) in which the response to treatment with inhaled
beclomethasone was not affected by BMI
* * The link between obesity and asthma is a hot topic in respiratory The link between obesity and asthma is a hot topic in respiratory
research and needs further investigations in order to clarify theresearch and needs further investigations in order to clarify the
consistency of itconsistency of it
Heffler E, Green RH, Brightling C and Pavord ID – submitted
OBESITY & ASTHMA
MYTH or REALITY?MYTH or REALITY?