Asthma and Obesity

ASTHMA AND OBESITY

Prof. Dr . Pop Monica UMF Iuliu Hatieganu Cluj-Napoca

Asthma and Obesity

Asthma

DEFINITION

- a chronic inflammatory disorder of the airways - expiratory airflow limitation, usually reversible under treatment or spontaneously - airway hyperresponsiveness that leads to recurrent exacerbations

GINA 2009, GAMA 2008 guidelines

Asthma and Obesity

Asthma

RISK FACTORS:

- allergens: domestic mites, furred animals, cockroach allergens, fungi, molds, yeasts - occupational sensitizer - tobacco smoke - outdoor/indoor air pollution - respiratory infections (viral) - physical activity, strong emotions - some drugs (aspirin, beta-blockers).
GINA 2009, GAMA 2008 guidelines

Asthma and Obesity

Inflammation in asthma

Peter J.Barnes, MD

Asthma and Obesity

Obesity

DEFINITION:

- nutrition disorder that means accumulation of excess fat on the body

TYPES OF OBESITY:

- exogenous - overeating - endogenous dysfunction of the endocrine or metabolic system (thyroid and pituitary obesity, Zondek obesity called water and salt)

http://www.who.int/topics/obesity/en/

Asthma and Obesity

Asthma and Obesity

IS THERE A RELATIONSHIP BETWEEN ASTHMA AND OBESITY?

Asthma and Obesity

Many studies tried to demonstrate the relationship between asthma and obesity.

Asthma and Obesity

An american study -California Teachers Study- which included 88.000 women, confirmed the correlation between obesity and an increased prevalence of asthma Obesity antedates asthma and appears to be a particularly important issue for severe asthma

www.myMED.ro

Asthma and Obesity

Obesity is a risk factor for asthma

The risk of asthma is double at obese women and triple at patients with morbid obesity (BMI over 40) Nurses Health Study: - in weight with 25 kg - risk of asthma 2,5x Obese patients with severe asthma account 75 % of asthma-related emergency room visits

Asthma and Obesity

Most of the studies demonstrated a stronger relationship asthma-obesity in females than in males, probably because a different hormonal status -obesity increase estrogen level decrease progesterone level -the same BMI: leptin level is greater at women comparing men
Obesity and asthma Stephanie A. Shore, Richard A. Johnston- Pharmacology and Therapeutics 110 (2006)83-102 - www.sciencedirect.com

Asthma and Obesity

Obese children are at higher risk of developing asthma that lean kids: 6,6% of childhood asthma is due to overweight Childhood obesity increases the risk of getting asthma in the adult life

1. AAAAI 2009: Childhood Obesity Linked to Asthma, Atopy-Martha Kerr http://www.medscape.com/viewarticle/589838 2. Asthma and obesity in children-Rachel E. Storya-http://www.sepeap.org/archivos/pdf/10711.pdf

Asthma and Obesity

Childhood obesity may restrict lung growth during development: changes in the pressure-volume curve of the lungs, altered pulmonary function risk for asthma Children of asthmatic parents may have a higher risk to develop asthma during childhood when their mothers are overweight during pregnancy says H.A. Smit, chief of Prevention and Health Services Research, National Institute of Public Health and Environment in Netherlands.

Asthma and Obesity

The asthma and obesity relationship

1. Common genetic predisposition: -chromosome 5q 2-adrenergic receptor gene-ADR2 influences sympathetic nervous system activity, controlling both airway tone and metabolic rate gene for glucocorticoid receptor-NR3C1 modulates inflammation -chromosome 6p HLA gene cluster(human leukocicyte antigen) +TNF the immune and inflammatory response -chromosome11q13 IgE receptor gene

Asthma and Obesity

The asthma and obesity relationship

2. Prenatal, neonatal and postnatal events can affect the subsequent development of obesity and asthma -low maternal BMI and failure to gain weight during the first trimester lower birth weight (increased percentage body fat and central fat distribution in children; centripetal obesity in adolescents and adults ) -higher maternal BMI and excessive weight gain tends to infants with a higher birth weight (accumulation of excess subcutaneous fat in childhood and the development of obesity as adults)
http://thorax.bmj.com/content/56/suppl_2/ii64.full?ijkey=ae594cf68ab15cebf8efaee80cba5c1a6ba 9fdfd&keytype2=tf_ipsecsha

Asthma and Obesity

The asthma and obesity relationship

-low birth weight: lower lung function risk for asthma

-higher birth weight: risk for obesity, that affects lung development: impact on lung anatomy, airway branching structure, the nature or distribution of connective tissue, the production of surfactant, the innervation of the tracheobronchial tree.
http://thorax.bmj.com/content/56/suppl_2/ii64.full?ijkey=ae594cf68ab15cebf8efaee80cba5 c1a6ba9fdfd&keytype2=tf_ipsecsha

In combination with genetic influences, alterations in the intrauterine nutritive environment can lead to diminished fetal growth (IUGR) during early gestation or increased birth weight during late gestation.

Tantisira K G , Weiss S T Thorax 2001;56:ii64-ii74

Asthma and Obesity

The asthma and obesity relationship

3. Predisposing factors: physical activity, diet -the relationship between obesity and asthma may just be a reflection of a sedentary lifestyle -increased physical fitness has been associated with decreases in the relative risk of incident asthma

Tantisira K G , Weiss S T Thorax 2001;56:ii64-ii74

Adjusted odds ratios (ORs) and 95% CIs for asthma and obesity according to eating behaviors in the past year in adolescents in France (polytomous logistic models).

Moreau D et al. Am J Clin Nutr 2009;89:1292-1298

Adjusted odds ratios (ORs) and 95% CIs for asthma and obesity according to weight concerns in the past year in adolescents in France (polytomous logistic models).

Moreau D et al. Am J Clin Nutr 2009;89:1292-1298

Adjusted odds ratios (ORs) and 95% CIs for asthma and obesity according to weight changes in the past year in adolescents in France (polytomous logistic model; n = 9457).

Moreau D et al. Am J Clin Nutr 2009;89:1292-1298

Asthma and Obesity

The asthma and obesity relationship

4. Obesity comorbidities that increases the severity of asthma: Gastroesophageal reflux (GER): -prevalence in asthmatics is 6080% in adults and 5060% in children bronchoconstriction, either by direct microaspiration or by vagally mediated reflex

-medical or surgical treatment of GER results in an improvement in asthma symptoms in about 70% of patients
http://thorax.bmj.com/content/56/suppl_2/ii64.full?ijkey=ae594cf68ab15cebf8efaee80cba5c1a6ba 9fdfd&keytype2=tf_ipsecsha

Asthma and Obesity

The asthma and obesity relationship

4. Obesity comorbidities that increases the severity of asthma :

Sleep-disordered breathing (SDB) Breathing at low lung volume -obesity in childhood may affect lung growth: smaller lungs and altered pulmonary function -obesity of the chest and abdominal walls may decrease the functional residual capacity
Obesity and asthma Stephanie A. Shore, Richard A. Johnston- Pharmacology and Therapeutics 110 (2006)83-102 - www.sciencedirect.com

Asthma and Obesity

Asthma and Obesity

Tantisira K G , Weiss S T Thorax 2001;56:ii64-ii74

Asthma and Obesity

The asthma and obesity relationship

5. Chronic systemic inflammation

6. Endocrine factors (adipokines and reproductive hormones) 7. Airway hyperresponsiveness

Asthma and Obesity

Chronic systemic inflammation

- systemic inflammation at obese patients: leptin TNF , IL-4, IL-5, IL 6, CRP growth factor eotaxin adiponectin airway inflammation (Harvard School of Public Health 2005)
Obesity and asthma Stephanie A. Shore, Richard A. Johnston- Pharmacology and Therapeutics 110 (2006)83-102 - www.sciencedirect.com Obesity and asthma J. Delgado, P.Barranco. S. Quirce-http://www.jiaci.org/issues/vol18issue6/2.pdf

Asthma and Obesity

Asthma and Obesity

Chronic systemic inflammation

- leptin= pro-inflammatory action, high level at obese -proliferation and activation of T cell -monocytes and macrophages activation -promoting angiogenesis = important for the normal development of the lung: critical mediator in the differentiation between lipofibroblasts and fibroblasts - adiponectin= anti-inflamatoary action, reduced in obese subjects
http://www.medicalnewstoday.com

Asthma and Obesity

Chronic systemic inflammation

- TNF -increases airway hyperresponsiveness -increases leptin, adiponectin and IL6 action

Obesity and asthma Stephanie A. Shore, Richard A. Johnston- Pharmacology and

Therapeutics 110 (2006)83-102 - www.sciencedirect.com

Asthma and Obesity

Hormonal factors

aromatase=the enzyme which is responsible for converting androgens into estrogens, is present in adipose tissue in obesity, the production of estrogens is generally increased and this is associated with early menarche in women and delay in the onset of puberty in men the prevalence of asthma was greater in those obese girls who had early menarche (before 11 years of age) than amongst those who underwent menarche at a later ageTucson cohort, Castro-Rodrguez et
http://thorax.bmj.com/content/56/suppl_2/ii64.full?ijkey=ae594cf68ab15cebf8efaee80cb a5c1a6ba9fdfd&keytype2=tf_ipsecsha

Asthma and Obesity

Airway hyperresponsiveness

- exercise induced bronchospasm is greater in obese versus lean patients - the pattern of bronchospasm, occurring soon after the exercise challenge, was consistent with that found in asthmatics

Obesity and asthma Stephanie A. Shore, Richard A. Johnston- Pharmacology and Therapeutics 110 (2006)83-102 - www.sciencedirect.com

Asthma and Obesity

Heart and obesity: - SAS, - Acute coronarian syndrom, - HTA, - Acute left ventricular failure, - Dyslipidemia.

Asthma and Obesity

A study from Boston University(2005) about the influence of obesity on asthma demonstrate that:

- WEIGHT LOSS in obese asthmatic improves pulmonary function, but does not reduce airway hyperresponsivenessobesity plays an important role in irreversible remodeling of the airways

Asthma and Obesity

Conclusion

Obesity influences the pulmonary function in many ways, but none of them is fully understood, so there are necessary more studies to explain better the asthmaobesity relationship.

www.pozemedicale.org