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Diagnosis, management and pathophysiology of obesity-related asthma: Anne E. Dixon, ATS 2023

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Published Online: Jun 12th 2023

Obesity-related asthma is associated with poorer control and a greater number of exacerbations of asthma, which in turn reduces patient quality-of-life. We were delighted to speak to Prof. Anne E. Dixon (University of Vermont Larner College of Medicine, Burlington, VT, USA) around the difficulties in the diagnosis and management of obese asthma, the association between metabolic dysfunction and asthma, and how obesity impacts exacerbations in patients with asthma.

The abstract ‘Is Obesity-Related Asthma a Bystander to Benefit From Treatment Strategies for Obesity-Mediated Metabolic Perturbations.‘ was presented at ATS 2023, 19-24 May 2023.

Questions

  1. What difficulties exist in the diagnosis and management of obese asthma? (0:16)
  2. What is already known about the association between metabolic dysfunction and asthma? (1:38)
  3. How does obesity impact symptoms and exacerbations in patients with asthma? (2:40)

Disclosures: Anne E. Dixon discloses receiving grant/research support from NIH, ALA, Inversago and MitoQ; serving on advisory boards for the American Board of Internal Medicine; and receiving honoraria from UpToDate and Springer.

Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Victoria Jones.

Filmed in coverage of the ATS Annual Meeting.

Click here for more content on asthma.

Transcript

What difficulties exist in the diagnosis and management of obese asthma? (00:15)

I think a lot of difficulties exist. One, I think, is just symptoms, so people who gain weight can get symptoms of shortness of breath that is not related to asthma at all. I think some people actually don’t ever get to a doctor because they actually blame it on the weight themselves when they’ve actually got a condition that could be treated. I think it’s critically important to remember that we need to check people’s lung function very carefully, in the same way as we would with lean people. There are some data that suggest some of the changes in the lung, particularly with obese asthma, particularly affect the periphery of the lung, which can be hard to detect with conventional lung function testing. So you have to be really careful. Then in terms of management, many times people with obesity and asthma just don’t respond as well to some of the standard medications that we use, such as inhaled corticosteroids, inhaled corticosteroid long-acting beta-agonist, so that can definitely make it more challenging. Another challenge is that markers of eosinophilic inflammation, such as exhaled nitric oxide, can actually be low in people with obesity even though they still have eosinophilic inflammation. So a number of different things that you really need to be aware of.

What is already known about the association between metabolic dysfunction and asthma? (01:38)

I would say that for a few years that we’ve known that inflammation in adipose tissue is particularly associated with obese asthma. So our own group and a group in Newcastle, Australia, both found that inflammation of visceral adipose tissue is associated with asthma in people with obesity. So, adipose tissue in them is more inflammatory than people who have obesity but don’t have asthma and then there’s been a lot of work done at the University of California at San Francisco that found that elevated interleukin six, and interleukin six is a mediator particularly produced by adipose tissue, and elevated interleukin-6 is particularly associated with poor asthma control. So we think that’s another marker that poor asthma control is associated with adipose tissue-related inflammation.

How does obesity impact symptoms and exacerbations in patients with asthma? (02:39)

There’s been a lot of work done both in adults and children that suggest that people with obesity and asthma tend to have poor asthma control, so they have worse symptoms, they use more rescue medication and there’s also increased risk of asthma exacerbations. In fact, there are publications to suggest that people with obesity and asthma have a nearly fivefold risk of being hospitalized for asthma exacerbation compared to lean people. So it really does have a pretty dramatic effect on asthma.

Subtitles and transcript are autogenerated

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