Treatment strategies for metabolic perturbations in obesity-related asthma: Anne E. Dixon, ATS 2023

Recent epidemiological studies have shown that treatments for obesity-mediated metabolic perturbations such as GLP-1 receptors might improve symptoms in obesity-related asthma. We were delighted to speak to Prof. Anne E. Dixon (University of Vermont Larner College of Medicine, Burlington, VT, USA) around the treatment strategies associated with obesity-mediated metabolic perturbations, the data surrounding weight loss as a strategy for asthma control and how biomarkers could be used to improve treatment strategies.

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 treatment strategies are associated with obesity-mediated metabolic perturbations and how could they improve asthma symptoms? (0:16)
2. What data surrounds weight loss as a strategy for asthma control? (1:08)
3. How could biomarkers to identify sub-phenotypes of obesity-related asthma improve treatment strategies? (2:46)

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 treatment strategies are associated with obesity-mediated metabolic perturbations and how could they improve asthma symptoms? (00:16)

I think we are just beginning to learn about that and so there have been a number of epidemiologic studies that suggest that some of the medications that we use to treat diabetes, such as the GLP-1 receptor agonists, such as metformin, might actually reduce asthma exacerbations in people who are on those medications for diabetes, as opposed to other medications. So, there’s some really provocative data that treating diabetes, particularly with medications perhaps that can induce weight loss but could also have anti-inflammatory effects in the lung, might be particularly efficacious. So, we’re still waiting for those clinical trials to be done.

What data surrounds weight loss as a strategy for asthma control? (01:08)

Yeah. I think weight loss is really important and I think this is something that people who deal with asthma don’t think about, but there actually is very good data that weight loss will improve asthma control. First of all, there’s data from patients with asthma undergoing bariatric surgery that really does suggest that bariatric surgery is associated with very significant improvements in asthma control and one publication, retrospective analysis, suggested that people with asthma who underwent bariatric surgery nearly halved their risk of asthma exacerbation after the bariatric surgery compared with before bariatric surgery. There’s also been studies done looking at lifestyle weight loss interventions, so they don’t lose as much weight as they do with bariatric surgery. Those studies suggest that people with obesity probably need to lose about five percent of their weight to improve their asthma control and I think that’s a really important thing for patients to know because, you know, we have lots of patients who really suffer with very severe obesity. They might be three hundred pounds, and they say to me, “Well, Dr. Dixon, I’m never going to get to one hundred and fifty pounds”, which is kind of what they think they need to do to be normal weight and I can say to them, “You know what? If you lost fifteen pounds, it could really improve your asthma control” and they’re like, “Yeah, that might be doable” and so I think it helps set realistic expectations that might be attainable rather than completely unrealistic expectations that patients just feel overwhelmed by.

How could biomarkers to identify sub-phenotypes of obesity-related asthma improve treatment strategies? (02:45)

Well, I think we need to use the same biomarkers as we use in lean asthma and just be very careful with them. So, measuring circulating eosinophils, measuring exhaled NO is very important. I think there’s a lot of data that suggests that circulating interleukin six may be associated with poor asthma control, though that’s not routinely available. But I think looking for evidence of diabetes, poorly controlled diabetes might be another marker that we should start thinking about, at least in some of the research that we do, because I suspect that it’s going to be associated particularly with poor asthma control that might be amenable to better treatment for their diabetes and metabolic inflammation as well as their asthma.

Subtitles and transcript are autogenerated