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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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A deep breath bronchoconstricts obese asthmatics.

Fernando Holguin1, Sushma Cribbs, Anne M Fitzpatrick

  • 1Asthma Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. holguinf@upmc.edu

The Journal of Asthma : Official Journal of the Association for the Care of Asthma
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Obese individuals with asthma experience worsened airway resistance after a deep breath (DB). This effect was not seen in leaner asthmatics or obese individuals without asthma, indicating a link between obesity and impaired DB response in asthma.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Asthma is characterized by impaired bronchodilation and bronchoprotection following a deep breath (DB).
  • Obesity can lead to lung restriction and increased airway resistance, potentially affecting DB-induced bronchodilation.
  • The impact of increasing body mass index (BMI) on the bronchodilatory response to DB in asthmatics remains unclear.

Purpose of the Study:

  • To investigate whether increasing BMI impairs the bronchodilatory response to a deep breath (DB) in individuals with asthma.
  • To compare the effects of DB on airway resistance across different BMI categories in asthmatic patients and obese controls.

Main Methods:

  • Ninety-nine subjects were studied: 87 with moderate to severe persistent asthma and 12 obese controls.
  • Airway resistance (Raw) was measured using transfer impedance after a standardized deep breath (DB) protocol.
  • Changes in Raw were analyzed in relation to body mass index (BMI) as both a categorical and continuous variable.

Main Results:

  • Obese asthmatics exhibited the largest percent increase in airway resistance (Raw) after a DB compared to overweight and lean asthmatics.
  • A significant trend (p=0.008) showed increasing Raw post-DB with higher BMI in asthmatics.
  • The association between percent increase in Raw after DB and BMI as a continuous variable was significant (p=0.02).

Conclusions:

  • In obese, moderate to severe, poorly controlled asthmatics, a deep breath (DB) leads to increased airway resistance (Raw).
  • This adverse effect of DB on airway resistance was not observed in leaner asthmatics of comparable severity.
  • Obese control subjects without asthma did not exhibit this phenomenon, suggesting a specific interaction between obesity and asthma in response to DB.