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Obesity and asthma. Key clinical questions

García-Rio F1,2,3, Alvarez-Puebla MJ1,4, De Esteban I5, Barranco P2,6, Olaguibel JM1,4

1Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)
2Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid
3Facultad de Medicina, Universidad Autónoma de Madrid
4Unidad de Asma Grave, Servicio de Alergia, Complejo Hospitalario de Navarra, Pamplona
5Hospital General de Villalba, Madrid
6Servicio de Alergia, Unidad de Asma Grave, Hospital Universitario La Paz-IdiPAZ, Madrid

J Investig Allergol Clin Immunol 2019; Vol. 29(4)
doi: 10.18176/jiaci.0316

Obesity is an asthma common comorbidity and is associated not only with its development, but also with a poorer control and higher severity of it. Recent prospective evidence supports the idea that body weight gain precedes the development of asthma, but the debate is far from over. The objective of this document is to conduct a systematic review of 3 clinical questions related to asthma and obesity:

  1. Obesity and asthma: the chicken or the egg? Clinical insights from epidemiological and phenotypes studies.
  2. Is obesity a confounding factor in the diagnosis and management of asthma and especially in severe or difficult-to-control asthma?
  3. How obese asthma subjects respond to pharmacological treatments, and to biological drugs? Do we have effective specific interventions?.

Revised epidemiological, pathological and mechanistic evidence combined with data from the intervention clinical trials do not allow us to clearly state that obesity is an asthma-causative agent. However, the complexity and heterogeneity of these two illnesses make several clinical scenarios possible. Furthermore, the diagnosis of asthma in an obese patient represents an additional clinical challenge. Physicians need to be aware of the confounding effects created by the greater symptomatic perception, the alterations of lung function and the different comorbidities that the obese subjects present. A exhaustive phenotyping of the obese asthma patient should lead us to a rational therapeutic plan, including both, the pharmacological approach and anti-obesity specific therapies including a combined plan of diet and exercise and in extreme cases, bariatric surgery.

Key words: Asthma, Obesity, Diet, Exercise, Phenotypes, Comorbidity, Asthma treatment