Allergy Asthma Respir Dis.  2014 Mar;2(1):16-22. 10.4168/aard.2014.2.1.16.

Association of body mass index with airway hyperresponsiveness and lung function in adult asthmatics

• Choi JE
• Shin TR
• Park SM
• Kim JH
• Shin SH
• Lee HY
• Jang J
• Lee HG
• Kim CH
• Hyun IG
• Choi JH

• KMID: 2168567
• DOI: http://doi.org/10.4168/aard.2014.2.1.16

Abstract

PURPOSE
Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. However, its relationships are not always consistent. Gender difference has been reported to influence asthma severity and asthma control. We investigated the contribution of obesity to airway hyperresponsiveness (AHR) and lung function before and after treatment in adult asthmatics.
METHODS
The medical records of a total of 323 adult asthmatics were analyzed retrospectively. Asthma was diagnosed based on the positive result of methacholine bronchial provocation test (PC20< or =25 mg/mL) or bronchodilator test (> or =12% and 200-mL improvement in forced expiratory volume in 1 second after inhalation of a bronchodilator). Follow-up spirometry was performed in 113 patients after at least 3 months of asthma treatment with controller medication. Percent change between spirometry before and after treatment was defined as {[(value after treatment-value before treatment)/value before treatment]x100}. Body mass index (BMI, weight [kg]/height [m2]) was categorized into underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (>30) according to the world health organization classification.
RESULTS
BMI did not show any significant correlation with PC20 value of methacholine provocation test and each lung function parameter before and after treatment. When we divided the study subjects according to gender and age, BMI was negatively correlated with PC20 value only in female adult asthmatics under 65 years old (r=-0.024, P=0.036).
CONCLUSION
Obesity is positively correlated with the intensity of AHR in female adult asthmatics. Gender seems to differentially contribute to the relationship between BMI and AHR.

Keyword

Asthma; Obesity; Airway hyperresponsiveness; Female

MeSH Terms

Adult*
Aged
Asthma
Body Mass Index*
Bronchial Provocation Tests
Classification
Female
Follow-Up Studies
Forced Expiratory Volume
Humans
Inhalation
Lung*
Medical Records
Methacholine Chloride
Obesity
Overweight
Retrospective Studies
Risk Factors
Spirometry
Thinness
World Health Organization
Methacholine Chloride

Figure

• 

  Fig. 1 Correlation between BMI and methacoline PC20 value (mg/mL) in the adult asthmatics according to gender. While BMI was not correlated with PC20 in the total adult asthmatics (<65 years, n=133) (A) and in the male group (n=59) (B), significant negative correlation was shown in the female group of adult asthmatics (n=74) (C). BMI was further significantly correlated with PC20 in young adult asthmatics (<45 years, n=59) (D) and in female young adult asthmatics (n=31) (F) while not in male young adult asthmatics (n=28) (E). P-values were analyzed by Spearman correlation tests. BMI, body mass index.

Reference

1. Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol. 2005; 115:897–909.

2. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004; 59:469–478.

3. Shore SA, Johnston RA. Obesity and asthma. Pharmacol Ther. 2006; 110:83–102.

4. Juel CT, Ulrik CS. Obesity and asthma: impact on severity, asthma control, and response to therapy. Respir Care. 2013; 58:867–873.

5. Shore SA. Obesity, airway hyperresponsiveness, and inflammation. J Appl Physiol (1985). 2010; 108:735–743.

6. Schachter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001; 56:4–8.

7. Kwon JW, Kim SH, Kim TB, Kim SH, Park HW, Chang YS, et al. Airway hyperresponsiveness is negatively associated with obesity or overweight status in patients with asthma. Int Arch Allergy Immunol. 2012; 159:187–193.

8. Varraso R, Siroux V, Maccario J, Pin I, Kauffmann F. Epidemiological Study on the Genetics and Environment of Asthma. Asthma severity is associated with body mass index and early menarche in women. Am J Respir Crit Care Med. 2005; 171:334–339.

9. Kattan M, Kumar R, Bloomberg GR, Mitchell HE, Calatroni A, Gergen PJ, et al. Asthma control, adiposity, and adipokines among inner-city adolescents. J Allergy Clin Immunol. 2010; 125:584–592.

10. James PT. Obesity: the worldwide epidemic. Clin Dermatol. 2004; 22:276–280.

11. Celedon JC, Palmer LJ, Litonjua AA, Weiss ST, Wang B, Fang Z, et al. Body mass index and asthma in adults in families of subjects with asthma in Anqing, China. Am J Respir Crit Care Med. 2001; 164(10 Pt 1):1835–1840.

12. Chinn S, Jarvis D, Burney P. European Community Respiratory Health Survey. Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey. Thorax. 2002; 57:1028–1033.

13. Maffei M, Halaas J, Ravussin E, Pratley RE, Lee GH, Zhang Y, et al. Leptin levels in human and rodent: measurement of plasma leptin and ob RNA in obese and weight-reduced subjects. Nat Med. 1995; 1:1155–1161.

14. Litonjua AA, Sparrow D, Celedon JC, DeMolles D, Weiss ST. Association of body mass index with the development of methacholine airway hyperresponsiveness in men: the Normative Aging Study. Thorax. 2002; 57:581–585.

15. Shore SA. Obesity and asthma: lessons from animal models. J Appl Physiol (1985). 2007; 102:516–528.

16. Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol. 2008; 121:1087–1093.

17. van Veen IH, Ten Brinke A, Sterk PJ, Rabe KF, Bel EH. Airway inflammation in obese and nonobese patients with difficult-to-treat asthma. Allergy. 2008; 63:570–574.

18. Lavoie KL, Bacon SL, Labrecque M, Cartier A, Ditto B. Higher BMI is associated with worse asthma control and quality of life but not asthma severity. Respir Med. 2006; 100:648–657.

19. Chang KJ, Koo HS, Lee HS, Jo YA. Association between asthma and obesity in national health and nutrition survey. Korean J Asthma Allergy Clin Immunol. 2005; 25:262–268.

20. Kanner RE, Connett JE, Altose MD, Buist AS, Lee WW, Tashkin DP, et al. Gender difference in airway hyperresponsiveness in smokers with mild COPD. The Lung Health Study. Am J Respir Crit Care Med. 1994; 150:956–961.

21. Castro-Rodriguez JA, Holberg CJ, Morgan WJ, Wright AL, Martinez FD. Increased incidence of asthmalike symptoms in girls who become overweight or obese during the school years. Am J Respir Crit Care Med. 2001; 163:1344–1349.

22. Foster PS, Goldie RG, Paterson JW. Effect of steroids on beta-adrenoceptor-mediated relaxation of pig bronchus. Br J Pharmacol. 1983; 78:441–445.

23. Hernandez Garcia IA, Gutierrez Gutierrez AM, Gallardo Lozano E. Effect of weight reduction on the clinical and hormonal condition of obese anovulatory women. Ginecol Obstet Mex. 1999; 67:433–437.

24. Takeda M, Tanabe M, Ito W, Ueki S, Konnno Y, Chihara M, et al. Gender difference in allergic airway remodelling and immunoglobulin production in mouse model of asthma. Respirology. 2013; 18:797–806.

25. Riffo-Vasquez Y, Ligeiro de Oliveira AP, Page CP, Spina D, Tavares-de-Lima W. Role of sex hormones in allergic inflammation in mice. Clin Exp Allergy. 2007; 37:459–470.

26. Cai Y, Zhou J, Webb DC. Estrogen stimulates Th2 cytokine production and regulates the compartmentalisation of eosinophils during allergen challenge in a mouse model of asthma. Int Arch Allergy Immunol. 2012; 158:252–260.

27. Clerisme-Beaty EM, Karam S, Rand C, Patino CM, Bilderback A, Riekert KA, et al. Does higher body mass index contribute to worse asthma control in an urban population? J Allergy Clin Immunol. 2009; 124:207–212.

28. Peters-Golden M, Swern A, Bird SS, Hustad CM, Grant E, Edelman JM. Influence of body mass index on the response to asthma controller agents. Eur Respir J. 2006; 27:495–503.