Obesity and asthma

Published on November 30, 2015   43 min

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The subject to my talk today is "Obesity and Asthma." My name is Dr. Anne Dixon. I'm Professor of Medicine and Director of the Division of Pulmonary and Critical Care Medicine at the University of Vermont.
To outline what I'm gonna talk about today, I'm gonna talk about the epidemiology linking obesity and asthma. I will then go on to talk about how obesity affects the clinical presentation of asthma, and particularly what it does to asthma control, and how it affects response to medications. I will discuss the data that we have regarding the efficacy of weight loss for the treatment of asthma in obesity, and what that revealed to us about the phenotypes of asthma in obesity, that I think this provides important insight into the mechanistic basis of asthma in patients who are obese. Finally, I will discuss the role of some of the co-morbidities we see in patients who are obese and the effect that those have on asthma.
It's well-known that there is a major obesity epidemic that is now worldwide. The slide I'm showing you here shows data from the World Health Organization. Obese women over the age of 15 are in the top figure, obese men are in the bottom figure. There's clearly an epidemic particularly affecting North America and South America, but is also very common in the Middle East, Australia and the countries of Polynesia. This is really becoming a worldwide epidemic.
It's really not until the late '90s that we began to realize that this obesity epidemic was affecting patients with asthma. And the first paper that really drew widespread attention to this epidemic was published by Carlos Camargo in the Archives of Internal Medicine in 1999. This was a large study which took advantage of the Nurses' Health Study in the United States. And Dr. Camargo looked at relative risk of developing new asthma in about 90,000 women. So this is incident asthma, and he looked at it relative to Body Mass Index. And using a reference BMI of 20 to 22.4, he found that there was an increasing risk of developing new asthma which increased in relationship to BMI. This was the first publication and it was in women. But there have been publications in men, in adults as well as in children, really reports from all over the world and in all ethnic groups. It is a little higher risk for women developing asthma in the setting of obesity, but it is true for all demographic groups.