Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
Bottom Line: The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood.Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure.Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making.
Affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA.Show MeSH
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Mentions: Recent studies suggest that there are at least two distinct phenotypes of asthma in obesity (Figure 1, Table 1).43,44 The obese state alters both early onset allergic asthma and also leads to the development of a novel form of late onset asthma, in part due to obesity.45–47 Patients with the atopic phenotype are likely to have pathophysiology consistent with early onset allergic asthma that is complicated by the development of obesity. Early onset allergic asthma is characterized by TH2 driven lymphocytic inflammation with increases in cytokines such as IL-4 and IL-5 that promote airway eosinophilia and IL-13 leading to mucus hypersecretion.42,43 Atopic asthma is an inflammatory disorder characterized by accumulation of eosinophils, mast cells, and CD4+ T lymphocytes, and with remodeling of the airway.Figure 1
Affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA.