Weight Loss Interventions for Adults With Obesity-Related Asthma

Abstract

Obesity is a common asthma comorbidity in adults, contributing to higher patient morbidity and mortality. Conversely, weight loss can reduce the impact of obesity on asthma and improve patient outcomes by diverse mechanisms including modulating airway inflammation, reducing oxidative stress, and improving lung function. Multiple lifestyle, nonpharmacological, pharmacological, and surgical interventions are effective at reducing weight in the general population. Fewer have been studied specifically in the context of patients with asthma. However, increasingly effective pharmacologic options for weight loss highlight the need for allergists and pulmonologists to understand the range of approaches that may directly or indirectly yield clinical benefits in asthma management. Weight loss interventions often require multidisciplinary support to create strategies that can realistically achieve a patient's personalized asthma and weight goals. This includes minimizing the adverse weight effects of glucocorticoids, which remain a mainstay of asthma management. Disparities in access, cost, and insurance coverage of weight loss interventions remain acute challenges for providers and patients. Future studies are needed to elucidate mechanisms of action of specific weight loss interventions on short-term and long-term asthma outcomes.

Keywords: Bariatric surgery; Body mass index; Diet; Disparities; Exercise; Glucagon-like peptide-1.

Figure 1.. Approach to integration of weight loss strategies in the management of asthma.

Management of asthma should include the promotion of healthy nutrition, lifestyle, and physical activity and the reduction of weight gain promoting therapies even before obesity develops. Interdisciplinary referrals to support weight loss should be considered if obesity is present.

Figure 2.. Body weight change across surgical and new pharmacologic options for weight management.

Study duration in weeks listed below each bar^{, , , , –, ,} . *denotes a study including patients with asthma in the study population. ^#denotes a study specifically excluding patients with asthma in the study population.