The Dual Burden of Obesity and Asthma: Implications for Respiratory Health and Asthma Control in Adults with Asthma

Öz

Asthma and obesity are both highly prevalent conditions with significant public health implications, and obesity has been identified as an aggravating factor in the pathogenesis of asthma. The present study aims to investigate differences in pulmonary function, lung diffusion capacity, functional exercise capacity, and asthma control between obese and non-obese adults with asthma. Fifty asthma patients were divided equally into obese and non-obese groups. Participants performed pulmonary function test (PFT), lung diffusion capacity, six-minute walk test (6MWT), and Asthma Control Test (ACT). No significant differences were found among groups in terms of PFT, lung diffusion capacity, and ACT (p>0.05). Significant differences were observed between groups in end-test SpO₂ (p = 0.045), baseline and end-test systolic blood pressure (p = 0.017 and p = 0.002), end-test respiratory rate (p = 0.002), perceptions of dyspnea and fatigue at both baseline and end-test (all p < 0.05), end-test leg pain (p = 0.045), and total walking distance (p = 0.038). A moderate and statistically significant negative correlation was found between body mass index (BMI) and the 6MWT distance (r = –0.592, p = 0.028). This study reveals that functional capacity is significantly impaired in patients with mild asthma, and obesity further aggravates this limitation. These results highlight the need for early functional evaluation and reinforce the importance of incorporating structured exercise and weight control into comprehensive asthma rehabilitation programs.

Anahtar Kelimeler

• Asthma
• Asthma control
• Functional exercise capacity
• Lung diffusion capacity
• Obesity
• Pulmonary function test

Obezite ve Astımın İkili Yükü: Astımlı Yetişkinlerde Solunum Sağlığı ve Astım Kontrolü Üzerindeki Etkileri

Öz

Astım ve obezite, her ikisi de önemli halk sağlığı sorunları olan yaygın durumlardır ve obezitenin astımın patogenezinde kötüleştirici bir faktör olduğu belirlenmiştir. Bu çalışma, astımı olan obez ve obez olmayan yetişkinler arasında akciğer fonksiyonları, akciğer diffüzyon kapasitesi, fonksiyonel egzersiz kapasitesi ve astım kontrolü açısından farklılıkları araştırmayı amaçlamaktadır. Elli astım hastası eşit şekilde obez ve obez olmayan iki gruba ayrılmıştır. Katılımcılara solunum fonksiyon testi (SFT), akciğer diffüzyon kapasitesi testi, altı dakikalık yürüme testi (6DYT) ve Astım Kontrol Testi (AKT) uygulanmıştır. Gruplar arasında SFT, akciğer diffüzyon kapasitesi ve AKT açısından anlamlı bir fark bulunmamıştır (p>0.05). Gruplar arasında test sonu SpO₂ (p = 0.045), başlangıç ve test sonu sistolik kan basıncı (p = 0.017 ve p = 0.002), test sonu solunum hızı (p = 0.002), hem başlangıç hem de test sonunda nefes darlığı ve yorgunluk algısı (tüm p < 0.05), test sonu bacak ağrısı (p = 0.045) ve toplam yürüme mesafesi (p = 0.038) açısından anlamlı farklar gözlemlenmiştir. Vücut kitle indeksi (VKİ) ile 6DYT mesafesi arasında orta düzeyde ve istatistiksel olarak anlamlı negatif bir korelasyon bulunmuştur (r = –0.592, p = 0.028). Bu çalışma, hafif astımı olan hastalarda fonksiyonel kapasitenin belirgin şekilde bozulduğunu ve obezitenin bu kısıtlamayı daha da kötüleştirdiğini ortaya koymaktadır. Bu sonuçlar, erken fonksiyonel değerlendirme gerekliliğini vurgulamakta ve yapılandırılmış egzersiz ile kilo kontrolünü içeren kapsamlı astım rehabilitasyon programlarının önemini pekiştirmektedir.

Anahtar Kelimeler

• Akciğer Difüzyon Kapasitesi
• Astım
• Astım kontrolü
• Fonksiyonel egzersiz kapasitesi
• Obezite
• Solunum Fonksiyon Testi

Kaynakça

1. 1. Venkatesan P. 2023 GINA report for asthma. Lancet Respir Med 2023;11(7):589.
2. 2. Dharmage SC, Perret JL, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr 2019;7:246.
3. 3. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol 2018;141(4):1169–79.
4. 4. Forno E, Weiner DJ, Mullen J, Sawicki G, Kurland G, Han YY, et al. Obesity and airway dysanapsis in children with and without asthma. Am J Respir Crit Care Med 2017;195(3):314–23.
5. 5. Tenório LHS, Vieira FC, Souza HCM, Andrade AdFD, Lorena VMB, Medeiros D, et al. Respiratory burden in obese and young asthmatics: a study of diaphragmatic kinetics. J Bras Pneumol 2021;47:e20210166.
6. 6. Mitchell I, Govias G. Comorbidities in Asthma. In: Asthma Education. Springer; 2021. p.291–331.
7. 7. Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med 2018;12(9):755–67.
8. 8. Bildstrup L, Backer V, Thomsen SF. Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics. J Asthma 2015;52(7):687–92.

9. 9. Bates JH, Peters U, Daphtary N, MacLean ES, Hodgdon K, Kaminsky DA, et al. Altered airway mechanics in the context of obesity and asthma. J Appl Physiol 2021;130(1):36–47.
10. 10. Sastre J, Olaguíbel J, López Viña A, Vega J, Del Pozo V, Picado C. Increased body mass index does not lead to a worsening of asthma control in a large adult asthmatic population in Spain. J Investig Allergol Clin Immunol 2010;20(7):551.
11. 11. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.
12. 12. Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2009. Fontana, WI: GINA; 2009. Available from: https://ginasthma.org
13. 13. Ra N. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004;113:59–65.
14. 14. Miller M, Hankinson J, Brusasco V. ATS/ERS TASK FORCE: standardisation of lung function testing – standardisation of spirometry. Eur Respir J 2005;26(2):319–38.
15. 15. Graham BL, Brusasco V, Burgos F, Cooper BG, Jensen R, Kendrick A, et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J 2017;49(1).
16. 16. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166(1):111–7.
17. 17. Sava F, Laviolette L, Bernard S, Breton M-J, Bourbeau J, Maltais F. The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD. BMC Pulm Med 2010;10(1):55.
18. 18. Beloncle FM, Richard J-C, Merdji H, Desprez C, Pavlovsky B, Yvin E, et al. Advanced respiratory mechanics assessment in mechanically ventilated obese and non-obese patients with or without acute respiratory distress syndrome. Crit Care 2023;27(1):343.
19. 19. Farah CS, Salome CM. Asthma and obesity: a known association but unknown mechanism. Respirology 2012;17(3):412–21.
20. 20. Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest 2006;130(3):827–33.
21. 21. Rastogi D, Fraser S, Oh J, Huber AM, Schulman Y, Bhagtani RH, et al. Inflammation, metabolic dysregulation, and pulmonary function among obese urban adolescents with asthma. Am J Respir Crit Care Med 2015;191(2):149–60.
22. 22. Fortis S, Corazalla EO, Wang Q, Kim HJ. The difference between slow and forced vital capacity increases with increasing body mass index: a paradoxical difference in low and normal body mass indices. Respir Care 2015;60(1):113–8.
23. 23. Schachter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax 2001;56(1):4–8.
24. 24. Steier J, Lunt A, Hart N, Polkey MI, Moxham J. Observational study of the effect of obesity on lung volumes. Thorax 2014;69(8):752–9.
25. 25. Baltieri L, Cazzo E, de Souza AL, Alegre SM, de Paula Vieira R, Antunes E, et al. Influence of weight loss on pulmonary function and levels of adipokines among asthmatic individuals with obesity: One-year follow-up. Respir Med 2018;145:48–56.
26. 26. Forte GC, Grutcki DM, Menegotto SM, Pereira RP, Dalcin Pde T. Prevalence of obesity in asthma and its relations with asthma severity and control. Rev Assoc Med Bras (1992). 2013;59(6):594–9.
27. 27. Ghabashi AE, Iqbal M. Obesity and its correlation with spirometric variables in patients with asthma. MedGenMed 2006;8(1):58.
28. 28. Al.Obaidi M. Comparison of Asthma Control Test (ACT) with (GINA) guidelines in the Assessment of Asthma Control and determine if can use Asthma Control Test ACT as alternative to Gina guidelines in control asthma. J Fac Med Baghdad 2014;58.
29. 29. Grzelewska-Rzymowska IF, Mikołajczyk J, Kroczyńska-Bednarek J, Górski P. Association between asthma control test, pulmonary function tests and non-specific bronchial hyperresponsiveness in assessing the level of asthma control. Pneumonol Alergol Pol 2015;83(4):266–74.
30. 30. Sutherland ER, Goleva E, King TS, Lehman E, Stevens AD, Fahy JV, et al. Cluster analysis of obesity and asthma phenotypes in the Severe Asthma Research Program. Am J Respir Crit Care Med. 2008;178(5): 451–458.
31. 31. Schatz M, Zeiger RS, Chen W, Yang SJ, Haselkorn T. The relationship of asthma impairment determined by psychometric tools to future asthma exacerbations. Chest. 2010;138(5):1151–1157.
32. 32. Ni Y, Yu Y, Dai R, Shi G. Diffusing capacity in chronic obstructive pulmonary disease assessment: A meta-analysis. Chronic Respir Dis 2021;18:14799731211056340.
33. 33. Benfante A, Tomasello A, Gianquinto E, Cicero MN, Scichilone N. Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management. Expert Rev Respir Med 2023;17(6):459–68.
34. 34. Enache I, Oswald-Mammosser M, Scarfone S, Simon C, Schlienger JL, Geny B, et al. Impact of altered alveolar volume on the diffusing capacity of the lung for carbon monoxide in obesity. Respiration 2011;81(3):217–22.
35. 35. Pruitt B. DLCO and Asthma Management. RT J Respir Care Pract 2024;37(5).
36. 36. Viegi G, Paoletti P, Carrozzi L, Baldacci S, Modena P, Pedreschi M, et al. CO diffusing capacity in a general population sample: relationships with cigarette smoking and airflow obstruction. Respiration 1993;60(3):155–61.
37. 37. Schultz CUB, Tupper OD, Ulrik CS. Static lung volumes and diffusion capacity in adults 30 years after being diagnosed with asthma. Asthma Res Pract 2022;8(1):4.
38. 38. Çiçek H, Turgut T. Astımda akciğer difüzyon kapasitesinin hava yolu obstrüksiyonu ile ilişkisi. Genel Tıp Dergisi 2007;17(4):205–9.
39. 39. Reimberg MM, Pachi JRS, Scalco RS, Serra AJ, Fernandes L, Politti F, et al. Patients with asthma have reduced functional capacity and sedentary behavior. J Pediatr (Rio J) 2020;96(1):53–9.
40. 40. Meys R, Janssen S, Franssen F, Vaes A, Stoffels A, van Hees H, et al. Test-retest reliability, construct validity and determinants of 6-minute walk test performance in adult patients with asthma. Pulmonology 2023;29(6):486–94.
41. 41. Oliveira MJ, Marçôa R, Moutinho J, Oliveira P, Ladeira I, Lima R, et al. Reference equations for the 6-minute walk distance in healthy Portuguese subjects 18–70 years old. Pulmonology 2019;25(2):83–9.
42. 42. Wright A, Lavoie KL, Jacob A, Rizk A, Bacon SL. Effect of body mass index on self-reported exercise-triggered asthma. Physician Sportsmed 2010;38(4):61–6.
43. 43. Pataky Z, Armand S, Müller‐Pinget S, Golay A, Allet L. Effects of obesity on functional capacity. Obesity 2014;22(1):56–62.
44. 44. Drinkard B, McDuffie J, McCann S, Uwaifo GI, Nicholson J, Yanovski JA. Relationships between walk/run performance and cardiorespiratory fitness in adolescents who are overweight. Phys Ther 2001;81(12):1889–96.
45. 45. Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J) 2010;86(6):497–502.
46. 46. Santuz P, Baraldi E, Filippone M, Zacchello F. Exercise performance in children with asthma: is it different from that of healthy controls? Eur Respir J 1997;10(6):1254–60.
47. 47. Reyes-Angel J, Kaviany P, Rastogi D, Forno E. Obesity-related asthma in children and adolescents. Lancet Child Adolesc Health 2022;6(10):713–24.
48. 48. Nicklas BJ, Brinkley TE, Houston DK, Lyles MF, Hugenschmidt CE, Beavers KM, et al. Effects of caloric restriction on cardiorespiratory fitness, fatigue, and disability responses to aerobic exercise in older adults with obesity: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2019;74(7):1084–90.
49. 49. Moczulska B, Żechowicz M, Leśniewska S, Nowek P, Osowiecka K, Gromadziński L. Obesity is associated with higher heart rate and excessive dyspnea with fatigue in the six-minute walk test. Pol Merkur Lekarski 2022;50(300):342–7.
50. 50. Lindgren M, Robertson J, Adiels M, Schaufelberger M, Åberg M, Torén K, et al. Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men. Int J Cardiol 2018;259:109–15.
51. 51. Hulens M, Vansant G, Claessens AL, Lysens R, Muls E. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports 2003;13(2):98–105.
52. 52. Bautista J, Ehsan M, Normandin E, Zuwallack R, Lahiri B. Physiologic responses during the six minute walk test in obese and non-obese COPD patients. Respir Med 2011;105(8):1189–94.
53. 53. Serés L, López-Ayerbe J, Coll R, Rodríguez O, Manresa JM, Marrugat J, et al. Cardiopulmonary function and exercise capacity in patients with morbid obesity. Rev Esp Cardiol 2003;56(6):594–600.
54. 54. Cortés-Télles A, Torre-Bouscoulet L, Silva-Cerón M, Mejía-Alfaro R, Syed N, Zavorsky GS, et al. Combined effects of mild-to-moderate obesity and asthma on physiological and sensory responses to exercise. Respir Med 2015;109(11):1397–403.
55. 55. Nazeer M, Jan Y, Rafiq N, Aara S. A comparative study of oxygen saturation (SpO₂) at rest and after 6-minute walking test in young adults with variable BMI. Indian J Public Health Res Dev 2023;14:149–54.
56. 56. Pathare N, Haskvitz EM, Selleck M. 6-minute walk test performance in young children who are normal weight and overweight. Cardiopulm Phys Ther J 2012;23(4):12–8.
57. 57. Taylor B, Mannino D, Brown C, Crocker D, Twum-Baah N, Holguin F. Body mass index and asthma severity in the National Asthma Survey. Thorax 2008;63:14–20.
58. 58. Chipps BE, Zeiger RS, Dorenbaum A, Borish L, Wenzel SE, Miller DP, et al. Assessment of asthma control and asthma exacerbations in the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) observational cohort. Curr Respir Care Rep 2012;1(4):259–69.
59. 59. 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(4):648–57.
60. 60. Boulet L-P, Franssen E. Influence of obesity on response to fluticasone with or without salmeterol in moderate asthma. Respir Med 2007;101(11):2240–7.
61. 61. 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(2):207–12.
62. 62. Pelegrino NR, Faganello MM, Sanchez FF, Padovani CR, Godoy I. Relationship between body mass index and asthma severity in adults. J Bras Pneumol 2007;33(6):641–6.
63. 63. Dixon AE, Shade DM, Cohen RI, Skloot GS, Holbrook JT, Smith LJ, et al. Effect of obesity on clinical presentation and response to treatment in asthma. J Asthma 2006;43(7):553–8.