Obesity and Asthma
Obesity and Asthma
US Respiratory Care 2005
Published: October 2008
Published: October 2008
Asthma report by Cleveland Moore, MD Associate Professor of Pediatrics, Louisiana State University Health Sciences Center Obesity Overweight and obesity have increased markedly over the last two decades. Approximately 65% of US adults are overweight or obese. Comparing the period1976-1980 with 1999-2000, the prevalence of overweight has increased by 40% (from 46.0% to64.5%) and the prevalence of obesity has risen by110% (from 14.5% to 30.5%).1-3 This increase is especially alarming in children and adolescents.
More than 10% of two- to five-year-olds and 15% of six- to19-year-olds are overweight. This represents a near doubling of overweight children and a near tripling of overweight adolescents over the last two decades.3 There has been a disproportionate rise in the prevalence of obesity among African-Americans and Hispanic/Mexican Americans in the US.This trend is not limited to the US; the prevalence of obesity isrising in other developed and affluent countries and is now spreading to less affluent countries.4 The health consequences of overweight and obesity are profound:- Heart disease - Twenty per cent to 30% of cardiovascular disease mortality may be attributable to excess body weight. 5- Hypertension - Hypertension is one of the most common conditions related to overweight and obesity.6- Diabetes - Data from the Nurses Health Study estimated that as much as 80% of type 2 diabetes mellitus could be attributed to the combined effectof inactivity and overweight.3- Cancer - Overweight and obesity have been linked to a variety of cancers (post-menopausal breastcancer, colon cancer, renal cancer, esophageal cancer,and endometrial cancer).3- Cerebrovascular disease - Rexrode et al. reportedthat the risk of ischemic stroke increased withbody mass index (BMI), and obese women had approximately twice the risk as lean women.7- Gallstones - Compared with women in the healthyweight range,overweight women have close to twicethe risk of developing gallstones, and obese women have two and a half to three times the risk. Similar trends of increased risk with higher BMI have been seen in men.8- Osteoarthritis - Compared with their leaner peers, overweight adults are at an increased risk of developing osteoarthritis of the knee and are more than twice aslikely to develop osteoarthritis in the hip. 3D yslipidemia, sleep apnea, cataracts, benign prostatic hypertrophy, menstrual irregularities,pregnancy complications, depression, and social discrimination are also more common in overweightand obese populations.3 The estimated costs of obesity in the US is US$117billion each year. This estimate includes both direc tcosts (related to diagnosis and treatment of illness,including doctor visits, medications, hospitalizations,and nursing homestays) and indirect costs (resulting from lost wages and productivity due to illness or premature death).9,10Asthma The prevalence of asthma has increased in recent decades and asthma is now considered the most common chronic disease in the pediatric age group.11 Inthe US, the National Health and Nutrition Examination Surveys found that asthma prevalence rosefrom 4.8% to 7.6% over a five-year period. The prevalence among children aged five to 14 increased74% from 42.8 per 1,000 in 1980 to an average of 74.4per 1,000 in 1993/94. In the UK, asthma prevalence increased from 6.9% in 1973 to 12.8% in 1986.12 Asthma morbidity and mortality are disproportionately high in inner-city populations and among ethnicminorities. Children with asthma have 1.9-fold moreambulatory visits, 2.2-fold more emergency visits, and3.5-fold more hospitalizations than children withoutasthma.The economic impact of asthma in 1998 was estimated to be US$11.3 billion. Direct costs accounted Obesity and AsthmaCleveland Moore, MD, joined Louisiana State University Medical School in New Orleans, LA, in 1993 where he is Associate Professor of Pediatrics, and Director of the Allergy-Immunology Fellowship Training Program. From 1990 to1992, Dr Moore was a Fellow in Allergy/Immunology at All Children-sHospital, St Petersburg, FL. Hepracticed with the Miller Medical Group in Nashville, TN, from 1988 to 1990, and opened a private solopractice in Mobile, AL, in 1984. He practiced medicine as a professor of pediatrics at Columbia University School of Medicine, Harlem Hospital Medical Center, New York after his residency at Mount Sinai Hospital,New York City, where he was a fellow in hematology/oncology. Dr Moore received his MD at Stanford University School of Medicine.
1BUSINESS BRIEFING: US RESPIRATORY CARE 2005 for US$7.5 billion and in direct costs were US$3.8billion. Hospitalizations accounted for the single largest portion of the cost.12 Obesity and Asthma The parallel increases in the prevalence of obesity and asthma may suggest an association between theconditions. A number of studies have documented apositive association between obesity and asthma prevalence and incidence in adults, especially women.
The cross-sectional diagnosis of asthma has been associated with obesity in both children and adults.13-21 Some studies have noted the relationship only inwomen or men.17,18,20,21 Increasing BMI has been associated with asthma symptoms, airway hyper-responsiveness, and atopy.22-27 Obesity may be a risk factor for the development ofasthma. In a prospective study of 85,911 women in the Nurses- Health Study, 1,596 incident cases of doctor-diagnosed asthma were identified. Using a multivariate analysis, the relative risk of asthma was 2.7 for obesewomen compared with non-obese women.28 Increasing weight gain led to a higher risk of asthma in these women.Women who gained 10-20kg since the age of18 had a relative risk of 1.4 of developing asthma compared with women whose weight remained stable.
Women who gained more than 25kg since the age of18 had a much higher relative risk of developing asthma of 2.7. A similar relationship between obesity and asthma is found in children. The Growing Up Today cohort of children noted 140 cases of incident asthma in boys over a one-year period and 160 cases of incident asthma in girls. Comparing the highest with the lowest quintile of BMI, the relative risk of asthmaduring that time was 2.3 in boys and 1.5 in girls.29 Notonly is obesity a risk factor for the development ofasthma, but overweight and obesity make currentasthma more severe.
References:
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6. Must A, Jacques P F, Coakley E H, Field A E, Colditz G, Dietz W H,-The disease burden associated with overweight and obesity-, JAMA (1999), 282: pp. 1,523-1,529 Abstract.
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8. Field A E, Coakley E H, Must A, Spadano J L, Laird N, Dietz W H, Rimm E, Colditz G A,-Impact of overweight on the risk of developing common chronic diseases during a 10-year period-, Arch. Intern. Med. (2001), 161: pp. 1,581-1,586 Abstract.
9. Centers for Disease Control and Prevention, -Trends and intake of energy and macronutrients-United States, 1971-2000-, MMWR Morb. Mortal.Wkly Rep. (2004), 53: pp. 80-82 Abstract.
10. Wolf A M,-What is the economic case for treating obesity?-, Obes. Res. (1998), 6 (Suppl 1): pp. 2S-7S Abstract.
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16.Negri E, Pagano R, Decaril A et al. Body weight and the prevalence of chronic diseases. J Epidemiol Community Health 1988;42:24-9 17. Seidell J C, de Groot L C, van Sonsbeek J L, et al.,-Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults-, Am. J. public Health (1988), 42: pp. 24-29.
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19. Schachter L M, Salome C M, Peat J K et al.,-Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness-, Thorax (2001), 56: pp. 4-8.
20.Shaheen S O, Steme J A, Montgomery S M, et al., -Birth weight, body mass index and asthma in young adults-, Thorax (1999), 54: pp. 396-402.
21. Cockery D W,Ware J H, Ferris B G, et al.,-Distribution of forced expiratory volume in one second and forced vital capacity inhealthy, white, never-smokers in six U.S cities-, Am. Rev. Respir. Dis. (1985), 131: pp. 511-520.
22. Figueroa-munoz et al., schachter et al., shaheen et al., Kaplan B A, Brush G, Mascie-Taylor C G,-The relationship of childhoodasthma and wheezy bronchitis with height, weight and body mass index-, Human Biol. (1987), 59: pp. 921-931.
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25. Kanner R E, Connett J E,Altose M D et al.,-Gender difference in airway hyperresonisiveness in smokers with mild COPD.
The Lung Health Study-, Am. J. Respir. Crit. Care Med. (1994), 150: pp. 956-961.
26. Kaplan T A, Montana -E,-Exercise-induced bronchospasm in nonasthmatic obese chidren-, Clin. Pediatr. (Phila) (1993), 32:pp. 220-225, Huang S L, Shiao G, Chou P,-Association between body mass index and allergy in teenage girls in Taiwan-,Clin. Exp.Allergy (1999), 29: pp. 323-329.
27. Xu B, Jarvelin M R, Pekkanes J,-Body build and atopy-, J. Allergy Clin. Immunol. (2000), 105: pp. 393-394.
28. Carmargo C A Jr,Weiss S T, Zhang S, et al.,-Prospective study of body mass index, weight change, and risk of adult onset asthmain women-, Arch. Intern. Med. (1999), 159: pp. 2,582-2,588.
29. Camargo C A Jr, Field A E, Colditz G A, et al.,-Body mass index and asthma in children ages 9-14-, Am. J. Respir. Crit.
Care Med. (1999), 159: p.A150.
30. Blandon Vijil V, Del Rio Navarro B, Berber Eslava A, Sienra Monge J J L,-Quality of life in pediatric patients with asthma withor without obesity:A pilot study-, Allergol. Immunopathol.(Madr.) (2004), 32: pp. 259-264.
31. Levy J I,Walker-Hood L K, Clougherty J E, Dodson R E, Steinbach S, Hynes H P,-Lung function, asthma symptoms, andquality of life for children in public housing in Boston: a case-series analysis-, Environmental Health:A global access Science source(2004), 3: p. 13.
32. Akerman M J, Calacanis C M, Madsen M K,-Relationship between asthma severity and obesity-, J Asthma (2004), 41: pp.
521-526.
33. Tantisira K G, Litonjua A A,Weiss S T, Fuhlbrigge A L,-Association of body mass with pulmonary function in the ChildhoodAsthma Management Program (CAMP)-, Thorax (2003), 58: pp. 1,036-1,041.
34.Guerra S,Wright A L, Morgan W J, Sherrill D L, Holberg C J, Martinez F D, -Persistence of asthma symptoms duringadolescence: role of obesity and age of onset of puberty-, Am. J. Respir. Crit. Care Med. (2004), 170: pp. 78-85.
35.Tantisira K G,Weiss S T,-Complex interactions in complex traits: obesity and asthma-, Thorax (2001), 56 (Suppl II): pp.
ii64-ii74.
36. Pelosi P, Croci M, Ravagnan I, et al.,-The effects of body mass on lung volumes, respiratory mechanics, and gas exchange duringgeneral anesthesia-, Anesth.Analg. (1998), 87: pp. 6,654-6,660.
37. Ding D J, Martin J G, Macklem P T,-Effects of lung volume on maximal methacholine-induced bronchoconstriction in normalhumans-, J. Appl. Physiol. (1987), 62: pp. 1,324-1,330.
38. Zerah F, Harf A, Perlemuter L, et al.,-Effects of obesity on respiratory resistance-, Chest (1993), 103: pp. 1,470-1,476.
39.[Troisi R J, Speizer F E,Willett W C, et al., -Menoapuse, postmenopausal estrogen preparations, and the risk of adult-onsetasthma.A prospective cohort study-, Am. J. Respir. Crit. Care Med. (1995), 152: pp. 1,183-1,188.
40. Salem M L, Matsuzaki G, Kishihara K, et al.,-Beta-estradiol suppresses T cell-mediated delayed-type hypersensitivity throughsuppression of antigen-presenting cell function and Th1 induction-, Int.Arch.Allergy Immunol. (2000), 121: pp. 161-169.
Obesity and AsthmaB USINESS BRIEFING: US RESPIRATORY CARE 2005441.Virchow J C, Kroegel C,Walker C, et al., -Inflammatory determinants of asthma severity: mediator and cellular changes inbronchoalveolar lavage fluid of patients with severe asthma-, J. Allergy Clin. Immunol. (1996), 98: pp. 768-774.
42. Tang C, Rolland J M,Ward C, et al.,-Modulatory effects of alveolar macrophages on CD4+ T-cell IL-5 responses correlate withIL-beta, IL-6, and IL-12 production-, Eur. Respir. J. (1999), 14: pp. 106-112.
43.Gosset P, Tsicopoulos A, Wallaert B, et al., -Tumor necrosis factor alpha _interleukin-6 production by human mononuclearphagocytes from allergic asthmatics after IgE-dependent stimulation-, Am. Rev. Respir. Dis. (1992), 146: pp. 768-774.
44.Wi cek A, Kokot F, Chudek J, Adamczak M,-The adipose tissue - a novel endocrine organ of interest to the nephrologists-,Nephrol. Dial.Transplant (2002), 17: pp. 191-195.
45.Bastard J P, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M,Vidal H, Hainque B,-Elevated levels of interleukin 6 arereduced in serum and subcutaneous adipose tissue of obese women after weight loss-, J. Clin. Endocrin. Metab. (2000), 85: pp.
3,338-3,342.
46.Bastard J P, Jardel C, Delattre J, Hainque B, Bruckert E, Oberlin F,-Evidence for a link between adipose tissue interleukin-6content and serum C-reactive protein concentrations in obese subjects-, Circulation (1999), 99: pp. 2,221-2,222.
47. Yudkin J S, Stehouwer C D A, Emeis J J, Coppack S W,-C-reactive protein in healthy subjects: associations with obesity, insulinresistance, and endothelial dysfunction. A potential role for cytokines originating from adipose tissue?-, Arterioscler.Thromb.
Vasc. Biol. (1999), 19: pp. 972-978 Abstract.
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2. French S A, Lin B H, Gutherie J F,-National trends in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998-, J. Am. Diet Assoc. (2003),103: pp. 1,326-1,331 Abstract.
3. Stein D J,Colditz G A,-Obesity: Special Features-The Epidemic of Obesity-, J. Clin. Endocrinol. Metab. (2004), 84: pp.
2,522-2,525.
4. Popkin B M,-The nutrition transition and its health implications in lowerincome countries-, Public Health Nutr. (1998), 1: pp. 5-21 Abstract.
5. Seidell J C,Verschuren W M, van Leer E M, Kromhout D, -Overweight, underweight, and mortality. A prospective study of 48,287 men and women-, Arch. Intern. Med. (1996), 156: pp. 958-963 Abstract.
6. Must A, Jacques P F, Coakley E H, Field A E, Colditz G, Dietz W H,-The disease burden associated with overweight and obesity-, JAMA (1999), 282: pp. 1,523-1,529 Abstract.
7. Rexrode K M, Hennekens C H,Willett W C, Colditz G A, Stampfer M J, RichEdwards J W, Speizer F E, Manson J E,-A prospective study of body mass index, weight change, and risk of stroke in women-, JAMA (1997), 277: pp. 1,539-1,545 Abstract.
8. Field A E, Coakley E H, Must A, Spadano J L, Laird N, Dietz W H, Rimm E, Colditz G A,-Impact of overweight on the risk of developing common chronic diseases during a 10-year period-, Arch. Intern. Med. (2001), 161: pp. 1,581-1,586 Abstract.
9. Centers for Disease Control and Prevention, -Trends and intake of energy and macronutrients-United States, 1971-2000-, MMWR Morb. Mortal.Wkly Rep. (2004), 53: pp. 80-82 Abstract.
10. Wolf A M,-What is the economic case for treating obesity?-, Obes. Res. (1998), 6 (Suppl 1): pp. 2S-7S Abstract.
11. Perry T,Wood R,-A jump start on allergen avoidance for expectant parents-, Ann.Allergy Asthma Immunol. (2003), 91: pp.
507-509.
12. National Institutes of Health, National Heart, Lung, and Blood Institute, Data Fact Sheet:Asthma Statistics, Jan, 1999.
13.Genusso J, Epstein L H, Paluch R A, et al. -The relationship between asthma and obesity in urban minority children and adolescents-, Arch. Pediatr.Adolec. Med. (1998), 152: pp. 1,197-1,200.
14.Figueroa-Munoz J I, Chinn S, Rona R J, -Association between obesity and asthma in 4-11 year old children in the UK-, Thorax (2001), 56: pp. 133-137.
15. Epstein L H,Wu Y W, Paluch R A, et al.,-Asthma and maternal body mass index are related to pediatric body mass index and obesity: results from the Third National Health and Nutrition Examination Survey-, Obes. Res. (2000), 8: pp. 575-581.
16.Negri E, Pagano R, Decaril A et al. Body weight and the prevalence of chronic diseases. J Epidemiol Community Health 1988;42:24-9 17. Seidell J C, de Groot L C, van Sonsbeek J L, et al.,-Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults-, Am. J. public Health (1988), 42: pp. 24-29.
18. Chen Y, Dales R, Krewski D et al.,-Increased effects of smoking and obesity on asthma among female Canadians: the National Population Health Survey, 1994-1995-, Am. J. Epidemiol. (1999), 150: pp. 255-262.
19. Schachter L M, Salome C M, Peat J K et al.,-Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness-, Thorax (2001), 56: pp. 4-8.
20.Shaheen S O, Steme J A, Montgomery S M, et al., -Birth weight, body mass index and asthma in young adults-, Thorax (1999), 54: pp. 396-402.
21. Cockery D W,Ware J H, Ferris B G, et al.,-Distribution of forced expiratory volume in one second and forced vital capacity inhealthy, white, never-smokers in six U.S cities-, Am. Rev. Respir. Dis. (1985), 131: pp. 511-520.
22. Figueroa-munoz et al., schachter et al., shaheen et al., Kaplan B A, Brush G, Mascie-Taylor C G,-The relationship of childhoodasthma and wheezy bronchitis with height, weight and body mass index-, Human Biol. (1987), 59: pp. 921-931.
23. Luder Melnik T A, DiMaio M,-Association of being overweight with greater asthma symptoms in inner city black and Hispanicchildren-, J. Pediatr. (1998), 132: pp. 699-703.
24. Belamarich P F, Luder E, Kattan M, et al.,-Do obese inner-city children with asthma have more symptoms than nonobese childrenwith asthma?-, Pediatrics (2000), 106: pp. 1,436-1,441.
25. Kanner R E, Connett J E,Altose M D et al.,-Gender difference in airway hyperresonisiveness in smokers with mild COPD.
The Lung Health Study-, Am. J. Respir. Crit. Care Med. (1994), 150: pp. 956-961.
26. Kaplan T A, Montana -E,-Exercise-induced bronchospasm in nonasthmatic obese chidren-, Clin. Pediatr. (Phila) (1993), 32:pp. 220-225, Huang S L, Shiao G, Chou P,-Association between body mass index and allergy in teenage girls in Taiwan-,Clin. Exp.Allergy (1999), 29: pp. 323-329.
27. Xu B, Jarvelin M R, Pekkanes J,-Body build and atopy-, J. Allergy Clin. Immunol. (2000), 105: pp. 393-394.
28. Carmargo C A Jr,Weiss S T, Zhang S, et al.,-Prospective study of body mass index, weight change, and risk of adult onset asthmain women-, Arch. Intern. Med. (1999), 159: pp. 2,582-2,588.
29. Camargo C A Jr, Field A E, Colditz G A, et al.,-Body mass index and asthma in children ages 9-14-, Am. J. Respir. Crit.
Care Med. (1999), 159: p.A150.
30. Blandon Vijil V, Del Rio Navarro B, Berber Eslava A, Sienra Monge J J L,-Quality of life in pediatric patients with asthma withor without obesity:A pilot study-, Allergol. Immunopathol.(Madr.) (2004), 32: pp. 259-264.
31. Levy J I,Walker-Hood L K, Clougherty J E, Dodson R E, Steinbach S, Hynes H P,-Lung function, asthma symptoms, andquality of life for children in public housing in Boston: a case-series analysis-, Environmental Health:A global access Science source(2004), 3: p. 13.
32. Akerman M J, Calacanis C M, Madsen M K,-Relationship between asthma severity and obesity-, J Asthma (2004), 41: pp.
521-526.
33. Tantisira K G, Litonjua A A,Weiss S T, Fuhlbrigge A L,-Association of body mass with pulmonary function in the ChildhoodAsthma Management Program (CAMP)-, Thorax (2003), 58: pp. 1,036-1,041.
34.Guerra S,Wright A L, Morgan W J, Sherrill D L, Holberg C J, Martinez F D, -Persistence of asthma symptoms duringadolescence: role of obesity and age of onset of puberty-, Am. J. Respir. Crit. Care Med. (2004), 170: pp. 78-85.
35.Tantisira K G,Weiss S T,-Complex interactions in complex traits: obesity and asthma-, Thorax (2001), 56 (Suppl II): pp.
ii64-ii74.
36. Pelosi P, Croci M, Ravagnan I, et al.,-The effects of body mass on lung volumes, respiratory mechanics, and gas exchange duringgeneral anesthesia-, Anesth.Analg. (1998), 87: pp. 6,654-6,660.
37. Ding D J, Martin J G, Macklem P T,-Effects of lung volume on maximal methacholine-induced bronchoconstriction in normalhumans-, J. Appl. Physiol. (1987), 62: pp. 1,324-1,330.
38. Zerah F, Harf A, Perlemuter L, et al.,-Effects of obesity on respiratory resistance-, Chest (1993), 103: pp. 1,470-1,476.
39.[Troisi R J, Speizer F E,Willett W C, et al., -Menoapuse, postmenopausal estrogen preparations, and the risk of adult-onsetasthma.A prospective cohort study-, Am. J. Respir. Crit. Care Med. (1995), 152: pp. 1,183-1,188.
40. Salem M L, Matsuzaki G, Kishihara K, et al.,-Beta-estradiol suppresses T cell-mediated delayed-type hypersensitivity throughsuppression of antigen-presenting cell function and Th1 induction-, Int.Arch.Allergy Immunol. (2000), 121: pp. 161-169.
Obesity and AsthmaB USINESS BRIEFING: US RESPIRATORY CARE 2005441.Virchow J C, Kroegel C,Walker C, et al., -Inflammatory determinants of asthma severity: mediator and cellular changes inbronchoalveolar lavage fluid of patients with severe asthma-, J. Allergy Clin. Immunol. (1996), 98: pp. 768-774.
42. Tang C, Rolland J M,Ward C, et al.,-Modulatory effects of alveolar macrophages on CD4+ T-cell IL-5 responses correlate withIL-beta, IL-6, and IL-12 production-, Eur. Respir. J. (1999), 14: pp. 106-112.
43.Gosset P, Tsicopoulos A, Wallaert B, et al., -Tumor necrosis factor alpha _interleukin-6 production by human mononuclearphagocytes from allergic asthmatics after IgE-dependent stimulation-, Am. Rev. Respir. Dis. (1992), 146: pp. 768-774.
44.Wi cek A, Kokot F, Chudek J, Adamczak M,-The adipose tissue - a novel endocrine organ of interest to the nephrologists-,Nephrol. Dial.Transplant (2002), 17: pp. 191-195.
45.Bastard J P, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M,Vidal H, Hainque B,-Elevated levels of interleukin 6 arereduced in serum and subcutaneous adipose tissue of obese women after weight loss-, J. Clin. Endocrin. Metab. (2000), 85: pp.
3,338-3,342.
46.Bastard J P, Jardel C, Delattre J, Hainque B, Bruckert E, Oberlin F,-Evidence for a link between adipose tissue interleukin-6content and serum C-reactive protein concentrations in obese subjects-, Circulation (1999), 99: pp. 2,221-2,222.
47. Yudkin J S, Stehouwer C D A, Emeis J J, Coppack S W,-C-reactive protein in healthy subjects: associations with obesity, insulinresistance, and endothelial dysfunction. A potential role for cytokines originating from adipose tissue?-, Arterioscler.Thromb.
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