Clinical Trial

. 2018 Mar;141(3):1096-1104.

doi: 10.1016/j.jaci.2017.04.047. Epub 2017 Jun 15.

Obesity's effect on asthma extends to diagnostic criteria

Njira Lugogo¹, Cynthia L Green², Noah Agada³, Siyi Zhang², Susanne Meghdadpour⁴, Run Zhou², Siyun Yang², Kevin J Anstrom², Elliot Israel⁵, Richard Martin⁶, Robert F Lemanske Jr⁷, Homer Boushey⁸, Stephen C Lazarus⁸, Stephen I Wasserman⁹, Mario Castro¹⁰, William Calhoun¹¹, Stephen P Peters¹², Emily DiMango¹³, Vernon Chinchilli¹⁴, Susan Kunselman¹⁴, Tonya S King¹⁴, Nikolina Icitovic¹⁵, Monica Kraft¹⁶

Affiliations

¹ Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich. Electronic address: nlugogo@umich.edu.
² Department of Biostatistics and BioInformatics, Duke University, Durham, NC.
³ Division of Pediatric Allergy and Immunology, Department of Pediatric Pulmonology, Riley Children's Hospital, and Eli Lilly and Company, Indianapolis, Ind.
⁴ Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Duke University, Durham, NC.
⁵ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
⁶ Department of Medicine, National Jewish Health and University of Colorado Denver, Denver, Colo.
⁷ Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
⁸ Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif.
⁹ Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, Calif.
¹⁰ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, Saint Louis, Mo.
¹¹ Division of Pulmonary, Critical Care, and Sleep and Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex.
¹² Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, NC.
¹³ Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, Columbia University, New York, NY.
¹⁴ Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa.
¹⁵ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁶ Department of Medicine, University of Arizona, Tucson, Ariz.

PMID: 28624608
PMCID: PMC6076889
DOI: 10.1016/j.jaci.2017.04.047

Clinical Trial

Obesity's effect on asthma extends to diagnostic criteria

Njira Lugogo et al. J Allergy Clin Immunol. 2018 Mar.

. 2018 Mar;141(3):1096-1104.

doi: 10.1016/j.jaci.2017.04.047. Epub 2017 Jun 15.

Authors

Affiliations

¹ Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich. Electronic address: nlugogo@umich.edu.
² Department of Biostatistics and BioInformatics, Duke University, Durham, NC.
³ Division of Pediatric Allergy and Immunology, Department of Pediatric Pulmonology, Riley Children's Hospital, and Eli Lilly and Company, Indianapolis, Ind.
⁴ Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Duke University, Durham, NC.
⁵ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
⁶ Department of Medicine, National Jewish Health and University of Colorado Denver, Denver, Colo.
⁷ Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
⁸ Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif.
⁹ Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, Calif.
¹⁰ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, Saint Louis, Mo.
¹¹ Division of Pulmonary, Critical Care, and Sleep and Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex.
¹² Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, NC.
¹³ Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, Columbia University, New York, NY.
¹⁴ Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa.
¹⁵ Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁶ Department of Medicine, University of Arizona, Tucson, Ariz.

PMID: 28624608
PMCID: PMC6076889
DOI: 10.1016/j.jaci.2017.04.047

Abstract

Background: The use of inflammatory biomarkers to delineate the type of lung inflammation present in asthmatic subjects is increasingly common. However, the effect of obesity on these markers is unknown.

Objectives: We aimed to determine the effect of obesity on conventional markers of inflammation in asthmatic subjects.

Methods: We performed secondary analysis of data from 652 subjects previously enrolled in 2 Asthma Clinical Research Network trials. We performed linear correlations between biomarkers and logistic regression analysis to determine the predictive value of IgE levels, blood eosinophil counts, and fraction of exhaled nitric oxide values in relationship to sputum eosinophil counts (>2%), as well as to determine whether cut points existed that would maximize the sensitivity and specificity for predicting sputum eosinophilia in the 3 weight groups.

Results: Overall, statistically significant but relatively weak correlations were observed among all 4 markers of inflammation. Within obese subjects, the only significant correlation found was between IgE levels and blood eosinophil counts (r = 0.33, P < .001); furthermore, all other correlations between inflammatory markers were approximately 0, including correlations with sputum eosinophil counts. In addition, the predictive value of each biomarker alone or in combination was poor in obese subjects. In fact, in obese subjects none of the biomarkers of inflammation significantly predicted the presence of high sputum eosinophil counts. Obese asthmatic subjects have lower cut points for IgE levels (268 IU), fraction of exhaled nitric oxide values (14.5 ppb), and blood eosinophil counts (96 cells/μL) than all other groups.

Conclusions: In obese asthmatic subjects conventional biomarkers of inflammation are poorly predictive of eosinophilic airway inflammation. As such, biomarkers currently used to delineate eosinophilic inflammation in asthmatic subjects should be approached with caution in these subjects.

Trial registration: ClinicalTrials.gov NCT00495157 NCT00565266.

Keywords: Asthma; eosinophils; fraction of exhaled nitric oxide; inflammatory markers; obesity.

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Figures

**FIG 1**
Receiver operating characteristic curves by weight group adjusted for all biomarkers of inflammation.

See this image and copyright information in PMC

Comment in

Biomarkers in obese asthma: Age of asthma onset matters!
Westerhof GA, Coumou H, Bel EHD. Westerhof GA, et al. J Allergy Clin Immunol. 2018 Apr;141(4):1541. doi: 10.1016/j.jaci.2017.12.989. Epub 2018 Feb 2. J Allergy Clin Immunol. 2018. PMID: 29410044 No abstract available.
Reply.
Lugogo NL, Green C, Kraft M. Lugogo NL, et al. J Allergy Clin Immunol. 2018 Aug;142(2):713-714. doi: 10.1016/j.jaci.2018.02.030. Epub 2018 Apr 11. J Allergy Clin Immunol. 2018. PMID: 29655585 No abstract available.

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Obesity's effect on asthma extends to diagnostic criteria

Affiliations

Obesity's effect on asthma extends to diagnostic criteria

Authors

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Abstract

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