Obesity and asthma - 05/04/18

Doi : 10.1016/j.jaci.2018.02.004

Ubong Peters, PhD ^a, Anne E. Dixon, MA, BM, BCh ^a, Erick Forno, MD, MPH ^b,^⁎
^a Pulmonary and Critical Care Medicine, University of Vermont, Burlington, Vt
^b Pediatric Pulmonary Medicine, Allergy, and Immunology, University of Pittsburgh, Pittsburgh, Pa

^∗Corresponding author: Erick Forno, MD, MPH, Division of Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224.Division of Pulmonary Medicine, Allergy, and ImmunologyChildren's Hospital of Pittsburgh4401 Penn AvePittsburghPA15224

Abstract

Information for Category 1 CME Credit

Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.

Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.

Date of Original Release: April 2018. Credit may be obtained for these courses until March 31, 2019.

Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.

Target Audience: Physicians and researchers within the field of allergic disease.

Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

List of Design Committee Members: Ubong Peters, PhD, Anne E. Dixon, MA, BM, BCh, and Erick Forno, MD, MPH (authors); Andrea Apter, MD, MA, MSc (editor)

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: A. E. Dixon has received grants from the National Institutes of Health, the American Lung Association, and Pfizer and has received personal fees from Vitaeris. The rest of the authors declare that they have no relevant conflicts of interest. A. Apter (editor) declares that she has no relevant conflicts of interest.

Activity Objectives:

1.	To understand the role that obesity plays as a risk factor for and disease modifier of asthma.
2.	To identify the mechanisms involved in asthma pathogenesis.
3.	To understand the evidence supporting lifestyle changes in influencing disease progression.
4.	To identify the clinical characteristics of obese asthma in children and adults.

Recognition of Commercial Support: This CME activity has not received external commercial support.

List of CME Exam Authors: Gagandeep Cheema, MD, Erica Ridley, MD, Eliane Abou-Jaoude, MD, and Christian Nageotte, MD.

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: The exam authors disclosed no relevant financial relationships.

Obesity is a vast public health problem and both a major risk factor and disease modifier for asthma in children and adults. Obese subjects have increased asthma risk, and obese asthmatic patients have more symptoms, more frequent and severe exacerbations, reduced response to several asthma medications, and decreased quality of life. Obese asthma is a complex syndrome, including different phenotypes of disease that are just beginning to be understood. We examine the epidemiology and characteristics of this syndrome in children and adults, as well as the changes in lung function seen in each age group. We then discuss the better recognized factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, and the genetics/genomics of obese asthma. Finally, we describe current evidence on the effect of weight loss and mention some important future directions for research in the field.

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Key words : Asthma, obesity, obese asthma, metabolic syndrome, microbiome

Abbreviations used : AHR, BMI, CAMP, ERV, FVC, ICS, ILC, NO, RCT, SCFA, SNP, TLC

Plan

Epidemiology of obesity and childhood asthma

Epidemiology of obesity and asthma in adults

Clinical characteristics of obese asthma in children

Clinical characteristics of obese asthma in adults

Obesity and lung function in pediatric patients

Lung function and AHR in obese adults

The role of diet

The microbiome and pathophysiology of obese asthma

Inflammatory and metabolic changes in obese asthmatic patients

Genetics, epigenetics, and genomics

Lifestyle weight-loss interventions

Bariatric surgery

Conclusions

E.F.'s contribution was supported in part by grants HL125666 and HL119952 from the US National Institutes of Health (NIH), a grant from Children's Hospital of Pittsburgh of UPMC, and an award from the Klosterfrau Foundation. U.P. and A.D. were supported by NIH grants HL133920 and HL130847.