Obesity and Asthma: Key Clinical Questions.

Area of Science:

• Pulmonology
• Epidemiology
• Metabolic Diseases

Background:

• Obesity is a significant comorbidity associated with asthma development, poorer disease control, and increased severity.
• The relationship between obesity and asthma, specifically whether obesity precedes asthma (the 'chicken or the egg' question), is complex and under ongoing investigation.
• Obesity presents diagnostic and management challenges in asthma, particularly in severe or difficult-to-control cases.

Purpose of the Study:

• To systematically review clinical questions regarding the link between obesity and asthma.
• To explore if obesity is a confounding factor in asthma diagnosis and management.
• To assess the response of obese asthma patients to pharmacological and biological treatments and evaluate specific interventions.

Main Methods:

• Systematic review of epidemiological and phenotyping studies.
• Analysis of pathological and mechanistic evidence.
• Examination of data from interventional clinical trials.

Main Results:

• While definitive causation is not established, obesity is strongly linked to asthma development, control, and severity.
• Obesity can confound asthma diagnosis and management due to altered symptom perception, lung function changes, and comorbidities.
• Obese asthma patients may have varied responses to standard asthma treatments, necessitating tailored therapeutic plans.

Conclusions:

• The interplay between obesity and asthma is complex and heterogeneous, with obesity posing significant challenges.
• Physicians must recognize and account for the confounding effects of obesity in asthma patients.
• Personalized treatment strategies, including pharmacological approaches and anti-obesity interventions (diet, exercise, bariatric surgery), are crucial for managing obese asthma patients.