ASTIM VE OBEZİTE

Abstract

Abstract

 Son yıllarda dünyada hem obezite hem de astım görülme sıklığı artmıştır. Her iki hastalığın birlikte artış göstermesi obezitenin mekanik etkisi, inflamasyon, oksidatif stres, genetik ve epigenetik faktörler, yaşam tarzı ve çevresel maruziyetler gibi birtakım ortak mekanizmalar ile açıklanmaya çalışılmaktadır. Obezitenin eşlik ettiği astımda semptomlar daha şiddetlidir, atak nedeni ile hastaneye yatış sıklığı artmıştır ve tedaviye cevap alınması güçtür. Ayrıca astım tedavilerinin pek çok yan etkisi vardır. Obezite ve astım arasındaki ilişki mekanizmalarının netleşmesi ile yeni tedavi yaklaşımları ortaya konmuştur. Diyet ve egzersiz ile obez astımlıların klinik seyrinin iyileştiği gösterilmiştir. Obezite cerrahisi ile olumlu sonuçlar bildirilmektedir. Metabolik sendromun eşlik ettiği hastalarda metformin ve statinlerin fayda sağladığını gösteren çalışmalar vardır. Antioksidan içeren diyetlerin de astım kontrolünde yararı vardır. Ancak bu tedavi seçeneklerine yönelik daha kapsamlı çalışmalara ihtiyaç duyulmaktadır.

Keywords

• astım,obezite

References

1. 1. Prevention and management of the global epidemicof obesity. Report of the WHO Consultation on Obesity (Geneva, June, 3–5, 1997). Geneva: WHO.
2. 2. World Health organization 2008; Global strategy on diet physical activity and health. 3. James WP. What are the health risks? The medical consequences of obesity and its health risks. Exp Clin Endocrinol Diabetes 1998;106(Suppl 2):1-6. 4.Sanchez-Recalde A, Carlos Kaski J. Diabetes mellitus, inflammation and coronary atherosclerosis: current and future perspectives. Rev Esp Cardiol 2001;54(6): 751-63.
3. 5. Boulet LP. Asthma and obesity Clin Exp Allergy 2013;43:8-21.
4. 6. Pradeepan S, Garrison G, Dixon AE. 2013. Obesity in asthma: Approaches to treatment. Curr Allergy
5. 7. Jones, R.L.Nzekwu, M.M. The effects of body mass index on lung volumes. Chest. 2006;130:827–833.
6. 8. Beuther DA, Weiss ST, Sutherland ER. Obesity and asthma. Am J Respir Crit Care Med 2006; 174:112-9. 9. Visser, M.Bouter, L.M.McQuillan, G.M. et al, Low-grade systemic inflammation in overweight children. Pediatrics. 2001;107:E13
7. 10. Park, H.S.Park, J.Y.Yu, R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-alpha and IL-6. Diabetes Res Clin Pract. 2005;69:29–35.
8. 11.Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115:911–919.

9. 12. Masuzaki H, Ogawa Y, Sagawa N, Hosoda K, Matsumoto T, Mise H, Nishimura H, Yoshimasa Y, Tanaka I, Mori T, Nakao K. Nonadipose tissue production of leptin: leptin as a novel placenta-derived hormone in humans. Nat Med. 1997;3:1029–1033.
10. 13. Brown, V.Warke, T.J.Shields, M.D. et al, T cell cytokine profiles in childhood asthma. Thorax. 2003;58:311–316
11. 14. Cembrzynska-Nowak, M.Szklarz, E.Inglot, A.D. et al, Elevated release of tumor necrosis factor-alpha and interferon-gamma by bronchoalveolar leukocytes from patients with bronchial asthma. Am Rev Respir Dis. 1993;147:291–295.
12. 15. Zumbach, M.S.Boehme, M.W.Wahl, P. et al, Tumor necrosis factor increases serum leptin levels in humans. J Clin Endocrinol Metab. 1997;82:4080–4082.
13. 16. Sood, A.Ford, E.S.Camargo, C.A. Jr. Association between leptin and asthma in adults. Thorax. 2006;61:300–305.
14. 17. Ajuwon KM, Spurlock ME. Adiponectin inhibits LPS-induced NF-kappaB activation and IL-6 production and increases PPARgamma2 expression in adipocytes. Am J Physiol Regul Integr Comp Physiol. 2005;288:R1220–R1225.
15. 18. Wolf AM, Wolf D, Rumpold H, Enrich B, Tilg H. Adiponectin induces the antiinflammatory cytokines IL-10 and IL-1RA in human leukocytes. Biochem Biophys Res Commun. 2004;323:630–635. 19. Engeli, S.Feldpausch, M.Gorzelniak, K. et al, Association between adiponectin and mediators of inflammation in obese women. Diabetes. 2003;52:942–947.
16. 20. Vincent, H.K.Innes, K.E.Vincent, K.R. Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity. Diabetes Obes Metab. 2007;9:813–839.
17. 21. Nadeem, A.Chhabra, S.K.Masood, A. et al, Increased oxidative stress and altered levels of antioxidants in asthma. J Allergy Clin Immunol. 2003;111:72–78.
18. 22. Dut, R.Dizdar, E.A.Birben, E. et al, Oxidative stress and its determinants in the airways of children with asthma. Allergy. 2008;63:1605–1609.
19. 23. Montuschi, P.Corradi, M.Ciabattoni, G. et al, Increased 8-isoprostane, a marker of oxidative stress, in exhaled condensate of asthma patients. Am J Respir Crit Care Med. 1999;160:216–220.
20. 24. Komakula, S.Khatri, S.Mermis, J. et al, Body mass index is associated with reduced exhaled nitric oxide and higher exhaled 8-isoprostanes in asthmatics. Respir Res. 2007;8:32.
21. 25. Sood, A.Qualls, C.Arynchyn, A. et al, Obesity-asthma association: is it explained by systemic oxidant stress?. Chest. 2009;136:1055–1062.
22. 26. Hallstrand, T.S.Fischer, M.E.Wurfel, M.M. et al, Genetic pleiotropy between asthma and obesity in a community-based sample of twins. J Allergy Clin Immunol. 2005;116:1235– 1241. 27. Turki, J.Pak, J.Green, S.A. et al, Genetic polymorphisms of the beta 2-adrenergic receptor in nocturnal and nonnocturnal asthma. Evidence that Gly16 correlates with the nocturnal phenotype. J Clin Invest. 1995;95:1635–1641.
23. 28. Large, V.Hellstrom, L.Reynisdottir, S. et al, Human beta-2 adrenoceptor gene polymorphisms are highly frequent in obesity and associate with altered adipocyte beta-2 adrenoceptor function. J Clin Invest. 1997;100:3005–3013.
24. 29. SyamsuYusuf, I.Budu et al, The effect of polymorphism of the beta-2 adrenergic receptor on the response to beta-2 agonist in bronchial asthma patients. Acta Med Indones. 2007;39:8–12 . 30. Lin, R.C.Wang, W.Y.Morris, B.J. High penetrance, overweight, and glucocorticoid receptor variant: case-control study. BMJ. 1999;319:1337–1338.
25. 31. Rosmond, R.Chagnon, Y.C.Holm, G. et al, A glucocorticoid receptor gene marker is associated with abdominal obesity, leptin, and dysregulation of the hypothalamic-pituitaryadrenal axis. Obes Res. 2000;8:211–218.
26. 32. Panek, M.Pietras, T.Antczak, A. et al, The role of functional single nucleotide polymorphisms of the human glucocorticoid receptor gene NR3C1 in Polish patients with bronchial asthma. Mol Biol Rep. 2012;39:4749–4757.
27. 33. Panek, M.Pietras, T.Antczak, A. et al, The N363S and I559N single nucleotide polymorphisms of the h-GR/NR3C1 gene in patients with bronchial asthma. Int J Mol Med. 2012;30:142–150.
28. 34. Aoki, T.Hirota, T.Tamari, M. et al, An association between asthma and TNF-308G/A polymorphism: meta-analysis. J Hum Genet. 2006;51:677–685.
29. 35. Sookoian, S.C.Gonzalez, C.Pirola, C.J. Meta-analysis on the G-308A tumor necrosis factor alpha gene variant and phenotypes associated with the metabolic syndrome. Obes Res. 2005;13:2122–2131.
30. 36. Gold, D.R.Damokosh, A.I.Dockery, D.W. et al, Body-mass index as a predictor of incident asthma in a prospective cohort of children. Pediatr Pulmonol. 2003;36:514–521.
31. 37. Figueroa-Munoz, J.I.Chinn, S.Rona, R.J. Association between obesity and asthma in 4-11 year old children in the UK. Thorax. 2001;56:133–137.
32. 38. Chen, Y.Dales, R.Tang, M. et al, Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian National Population Health Surveys. Am J Epidemiol. 2002;155:191–197.
33. 39. Chen Y, Dales R, Jiang Y. The association between obesity and asthma is stronger in nonallergic than allergic adults. Chest 2006;130:890-5. 40. Guerra, S.Sherrill, D.L.Bobadilla, A. et al, The relation of body mass index to asthma, chronic bronchitis, and emphysema. Chest. 2002;122:1256–1263.
34. 41. Seidell, J.C.de Groot, L.C.van Sonsbeek, J.L. et al, Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults. Am J Public Health. 1986;76:264–269.
35. 42. Chandler, M.H.Schuldheisz, S.Phillips, B.A. et al, Premenstrual asthma: the effect of estrogen on symptoms, pulmonary function, and beta 2-receptors. Pharmacotherapy. 1997;17:224–234. 43. Lange, P.Parner, J.Prescott, E. et al, Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms: a cross sectional study of the general population. Thorax. 2001;56:613–616.
36. 44. Troisi, R.J.Speizer, F.E.Willett, W.C. et al, Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study. Am J Respir Crit Care Med. 1995;152:1183–1188. 45. Maffei, M.Halaas, J.Ravussin, E. 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.
37. 46. Thomas, T.Burguera, B.Melton, L.J. III et al, Relationship of serum leptin levels with body composition and sex steroid and insulin levels in men and women. Metabolism. 2000;49:1278–1284.
38. 47. Hickey, M.S.Israel, R.G.Gardiner, S.N. et al, Gender differences in serum leptin levels in humans. Biochem Mol Med. 1996;59:1–6.
39. 48. Assad N, Qualls C, Smith LJ, Arynchyn A, Thyagarajan B, Schuyler M, Jacobs DR, Jr, Sood A. Body mass index is a stronger predictor than the metabolic syndrome for future asthma in women. The longitudinal CARDIA study. Am J Respir Crit Care Med. 2013;188:319–326.
40. 49. Kılıç H, Oguzülgen IK, Bakır F, et al. Asthma in obese women: outcomes and factors involved. J Investig Allergol Clin Immunol 2011;21: 290-6.
41. 50. Ruesten, A.Steffen, A.Floegel, A. et al, Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015. PLoS One. 2011;6:e27455.
42. 51. Srivastava, A.Cotton, C.Paterson, A.D. Sex- and age-of-onset-based locus heterogeneity in asthma. Genet Epidemiol. 2001;21:S154–S159.
43. 52. McCallister, J.W.Parsons, J.P.Mastronarde, J.G. The relationship between gastroesophageal reflux and asthma: an update. Ther Adv Respir Dis. 2011;5:143–150.
44. 53. Gunnbjornsdottir, M.I.Omenaas, E.Gislason, T. et al, Obesity and nocturnal gastrooesophageal reflux are related to onset of asthma and respiratory symptoms. Eur Respir J. 2004;24:116–121.
45. 54. Al-Shawwa, B.A.Al-Huniti, N.H.DeMattia, L. et al, Asthma and insulin resistance in morbidly obese children and adolescents. J Asthma. 2007;44:469–473.
46. 55. Polikepahad, S.Moore, R.M.Venugopal, C.S. Endothelins and airways–a short review. Res Commun Mol Pathol Pharmacol. 2006;119:3–51. 56. Rasmussen, F.Lambrechtsen, J.Siersted, H.C. et al, Low physical fitness in childhood is associated with the development of asthma in young adulthood: the odense schoolchild study. Eur Respir J. 2000;16:866–870.
47. 57. Laitinen, J.Power, C.Ek, E. et al, Unemployment and obesity among young adults in a northern Finland 1966 birth cohort. Int J Obes Relat Metab Disord. 2002;26:1329–1338.
48. 58. Rosmond, R.Bjorntorp, P. Psychosocial and socio-economic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes Relat Metab Disord. 1999;23:138–145.
49. 59. Ahluwalia, S.K.Matsui, E.C. The indoor environment and its effects on childhood asthma. Curr Opin Allergy Clin Immunol. 2011;11:137–143.
50. 60. Huovinen, E.Kaprio, J.Koskenvuo, M. Factors associated to lifestyle and risk of adult onset asthma. Respir Med. 2003;97:273–280.
51. 61. Scott HA, Gibson PG, Garg ML, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy 2013;43:36-49.
52. 62. Poirier, P.,T.D.Giles, G.A.Bray, et al. 2006. Obesty and cardiovascular disease: pathophysiology, evaluation and effect of weight loss: an update of the 1997 American Heart Association Scientific Steatment on Obesity and Heart Desease from the Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism. Circulation 113:898-918.
53. 63. Stenius-Aarniala B, Poussa T, Kvarnstrom J, et al. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000; 320:827-32.
54. 64. Dixon AE, Pratley RE, Forgione PM, et al. 2011. Effects of obesyt and bariatric surgery an airway hyperresponsiviness, asthma control and inflammation. J Allergy Clin Immunol 128:508-515.
55. 65. Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol 2005; 115:897-909.
56. 66. Marrow VA, Foufelle F, Connell JM, et al. Direct activation of AMP- activated protein kinase stimulates nitric-oxide synthesis in human aortic endothelial cells. J Biol Chem 2003;278(34):31629-39.
57. 67. Davis B, Rahman A, Arner A. AMP –activated kinase relaxes agonist induced contractions in the Mouse aorta via effects on PKC signaling and inhibits NO induced relaxasion. Eur J Pharmacol 2012;695(1-3):88-95.
58. 68. Park CS, Bang BR, Kwon HS, et al. Metformin reduces airway inflammation and remodeling via activation of AMP-activated protein kinase Biochem Pharmacol 2012;84(12):1660-70.
59. 69. Zeki AA, Oldham J, Wilson M, et al. Statin use and asthma control in patients with severe asthma. BMJ Open 2013;3(8).
60. 70. Wood LG, Garg ML, Smart JM, Scott HA, Barker D, Gibson PG. 2012. Manipulating antioxidant intake in asthma: A randomized controlled trial. Am J Clin Nutr 96:534-543. 71. Allen S, Britton JR,Leonardi-Bee JA. Association between antioxidant vitamins and asthma outcome measures:systematic review and meta-analysis. Thorax 2009;64(7):610-9.
61. 72.Ahmad SM, Haskell MJ, Ragip R, et al. Vitamin A status is associated with T- cell responses in Bangladeshi men. Br J Nutr 2009;102(6):797-802.
62. 73. Pathak K, Soares MJ, Calton EK, et al. Vitamin D supplementation and body weight status: a asystematic review and metaanalysis of randomized controlled trials. Obes Rev 2014;15:528-34.
63. 74. Milan SJ, Hart A, Wilkinson M. Vitamin C for asthma and exercise- induced bronchoconstriction. Conchrance Database Sysy Rev 2013;(10):CD010391.
64. 75. Keaney JF Jr, Gaziano JM, Xu A, et al. Dietary antioxidants preserve endothelium- dependent vessel relaxation in cholesterol-fed rabbits. Proc Natl Acad Sci U S A 993;90(24):11880-4.
65. 76. Nakamura T, Azuma A, Kuribayashi T, et al. Serum fatty acid levels, dietary style and coronary hearth disease in three neighbouring areas in Japan: the Kumihami study Br J Nutr 2003;89:267-72.