Obesity and Asthma in Children-Coexistence or Pathophysiological Connections?

Abstract

The aim of this narrative review is to explore possible connections that might lead to both obesity and asthma; it will explain factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, lung function, the genetics/genomics of obese asthma, risk of exacerbation, atopy, and response to treatment. It highlights the role that obesity plays as a risk factor for and disease modifier of asthma, understanding the evidence supporting lifestyle changes in influencing disease progression. Pathophysiological mechanisms in obesity-related asthma have influences on the course of disease pathology. Due to these factors, the child with obese asthma needs a specific therapeutic approach taking into account the common unresponsiveness to bronchodilators, increased requirements for controller medications, poorer steroid effectiveness, and better response to leukotriene receptor (LTR) inhibitors. Therapeutic strategies centered on prevention are suggested and the development of resources to assist families with weight loss strategies and lifestyle changes is shown to be useful for effective weight control and optimal asthma management. Obese children with asthma generally should receive interventions that encourage daily physical activity, weight loss, and normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult to control asthma. Recognizing and identifying an asthmatic patient is not always easy and a detailed medical history of the patient, with particular attention paid to their presenting and past symptoms, and a complete physical examination play pivotal and fundamental roles in determining the final diagnosis.

Keywords: asthma; obesity; pathophysiological mechanisms.

Figure 1

Factors associated with obesity-related asthma.

Figure 2

Adipose tissue and obesity-related inflammation. (T helper cell 1 (Th1), fibroblast growth factor 21 (FGF21), interleukin 10 (IL-10), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF alpha)).

Figure 3

Macrometabolites, micrometabolites, and obesity-related asthma. (High-density lipoproteins (HDL) and short-chain fatty acids (SCFAs)).

Figure 4

Selected pathways involved in obesity-related asthma and potential interventions for the management of patients with asthma in the setting of obesity. (Glucagon-like peptide-1 receptor (GLP-1R), selective serotonin reuptake inhibitor (SSRI), Cognitive behavioral therapy (CBT), gastroesophageal reflux (GER), Obstructive Sleep Apnea Syndrome (OSAS), Noninvasive Positive Pressure Ventilation (NIPPV)).