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- W1981190339 abstract "Asthma, allergy, and obesity are common health problems, and their prevalence is increasing (Fig 1).1Mokdad A.H. Serdula M.K. Dietz W.H. Bowman B.A. Marks J.S. Koplan J.P. The spread of the obesity epidemic in the United States, 1991-1998.JAMA. 1999; 282: 1519-1522Crossref PubMed Scopus (1916) Google Scholar Obesity is defined by a body mass index of greater than 30. Over the last few years, a number of studies have described an association between obesity and asthma (Fig 2).2Hancox R.J. Milne B.J. Poulton R. Taylor D.R. Greene J.M. McLachlan C.R. et al.Sex differences in the relation between body mass index and asthma and atopy in a Birth Cohort.Am J Respir Crit Care Med. 2005; 171: 440-445Crossref PubMed Scopus (213) Google Scholar, 3Wickens K. Barry D. Friezema A. Rhodius R. Bone N. Purdie G. et al.Obesity and asthma in 11-12 year old New Zealand children in 1989 and 2000.Thorax. 2005; 60: 7-12Crossref PubMed Scopus (74) Google Scholar, 4Tantisira K.G. Litonjua A.A. Weiss S.T. Fuhlbrigge A.L. Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP).Thorax. 2003; 58: 1036-1041Crossref PubMed Scopus (189) Google Scholar, 5Hedberg A. Rossner S. Body weight characteristics of subjects on asthma medication.Int J Obes Relat Metab Disord. 2000; 24: 1217-1225Crossref PubMed Scopus (30) Google Scholar, 6Guerra S. Sherrill D.L. Bobadilla A. Martinez F.D. Barbee R.A. The relation of body mass index to asthma, chronic bronchitis, and emphysema.Chest. 2002; 122: 1256-1263Crossref PubMed Scopus (286) Google Scholar, 7Chinn S. Jarvis D. Burney P. Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey.Thorax. 2002; 57: 1028-1033Crossref PubMed Scopus (176) Google Scholar In a large population of white Australian girls, a higher body mass index was reported to be a risk factor for atopy and wheeze.8Schachter L.M. Peat J.K. Salome C.M. Asthma and atopy in overweight children.Thorax. 2003; 58: 1031-1035Crossref PubMed Scopus (183) Google Scholar As a corollary, weight loss, as after bariatric surgery, has consistently been shown to improve asthma severity and control (Fig 3).9Simard B. Turcotte H. Marceau P. Biron S. Hould F.S. Lebel S. et al.Asthma and sleep apnea in patients with morbid obesity: outcome after bariatric surgery.Obes Surg. 2004; 14: 1381-1388Crossref PubMed Scopus (90) Google ScholarFig 2Association of high body mass index with asthma. In female subjects asthma is more prevalent in overweight and obese individuals. Reproduced with permission from Hancox et al.2Hancox R.J. Milne B.J. Poulton R. Taylor D.R. Greene J.M. McLachlan C.R. et al.Sex differences in the relation between body mass index and asthma and atopy in a Birth Cohort.Am J Respir Crit Care Med. 2005; 171: 440-445Crossref PubMed Scopus (213) Google ScholarView Large Image Figure ViewerDownload (PPT)Fig 3A, Asthma severity among morbidly obese asthmatic subjects before bariatric surgery. B, Changes in asthma severity after bariatric surgery. Close to 70% of obese asthmatic subjects have moderate-to-severe asthma. Two years after the bariatric surgery, 80% of obese asthmatic subjects have considerably improved their asthma symptoms and control. Reproduced with permission from Obesity Surgery 2004;14:1381-8.View Large Image Figure ViewerDownload (PPT)Changes in airway structure and function have been associated with obesity. For example, it is common to observe an atypical obese airway pattern in morbidly obese persons at bronchoscopy (Fig 4). This pattern is believed to be attributed to fat infiltration and might be responsible for airway narrowing. In regard to physiologic changes, Boulet et al10Turcotte H. Simard B. Boulay M.E. Boulet L.P. Influence of body mass index (BMI) on the effect of deep inspiration avoidance (DIA) on airway response to methacholine (M).Am J Respir Crit Care Med. 2004; 169: A246Google Scholar recently reported that obese subjects had lost the protective effect of deep inhalation to methacholine-induced bronchoconstriction that was observed in nonobese individuals (Fig 5).Fig 4Airways of a morbidly obese person (A) and of a nonobese person (B). In morbidly obese individuals it is common to observe widening of the bifurcation and a less-defined cartilage ring. BMI, Body mass index.View Large Image Figure ViewerDownload (PPT)Fig 5Absence of a protective effect of deep inhalation to methacholine-induced bronchoconstriction in obese subjects. For a similar dose of methacholine, avoidance of deep inspiration for a 20-minute period before methacholine challenge increased the decrease in FEV1 compared with nonavoidance in nonobese subjects (blue circles, body mass index [BMI] <30; P = .0003), whereas no difference was observed in obese subjects (red circles, body mass index ≥30; P > .05).View Large Image Figure ViewerDownload (PPT)Fat tissue in obese persons is a source of inflammatory mediators (Table I)11Wajchenberg B.L. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome.Endocr Rev. 2000; 21: 697-738Crossref PubMed Scopus (1674) Google Scholar that might be implicated in asthma pathophysiology. Leptin is of particular interest because it has been found to be present in higher levels in obese asthmatic subjects compared with in obese nonasthmatic subjects (Fig 6).12Mai X.M. Bottcher M.F. Leijon I. Leptin and asthma in overweight children at 12 years of age.Pediatr Allergy Immunol. 2004; 15: 523-530Crossref PubMed Scopus (98) Google Scholar Leptin, an adipocyte-derived hormone, has been suggested to upregulate the inflammatory immune response. In an animal model of asthma, Shore et al13Shore S.A. Schwartzman I.N. Mellema M.S. Flynt L. Imrich A. Johnston R.A. Effect of leptin on allergic airway responses in mice.J Allergy Clin Immunol. 2005; 115: 103-109Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar recently showed that the allergen airway response is increased in the presence of leptin. They found that airway hyperresponsiveness, the number of BAL eosinophils and lymphocytes, and IL-4, IL-5, and IL-13 levels are all increased in leptin-treated animals compared with control animals.Table IInflammatory mediators produced by fat tissueMediators releaseVisceral fatSubcutaneous fatLeptin+++TNF-α++IL-6+++Plasminogen activator inhibitor 1+++Insulin-like growth factor 1++Modified with permission from Wajchenberg.12Mai X.M. Bottcher M.F. Leijon I. Leptin and asthma in overweight children at 12 years of age.Pediatr Allergy Immunol. 2004; 15: 523-530Crossref PubMed Scopus (98) Google Scholar Open table in a new tab Fig 6High levels of leptin in overweight children with asthma. High levels of serum leptin are present in overweight children, and even higher levels are found in asthmatic overweight children. Reproduced with the permission of Blackwell Publishing from Mai XM, Bottcher MF, Leijon I. Leptin and asthma in overweight children at 12 years of age. Pediatr Allergy Immunol 2004;15:523-30.View Large Image Figure ViewerDownload (PPT)However, despite the animal, epidemiologic, and physiologic evidence to date, there have been no reports yet of a comprehensive study that shows a substantial difference in the pathology of asthma in obese compared with nonobese patients. Asthma, allergy, and obesity are common health problems, and their prevalence is increasing (Fig 1).1Mokdad A.H. Serdula M.K. Dietz W.H. Bowman B.A. Marks J.S. Koplan J.P. The spread of the obesity epidemic in the United States, 1991-1998.JAMA. 1999; 282: 1519-1522Crossref PubMed Scopus (1916) Google Scholar Obesity is defined by a body mass index of greater than 30. Over the last few years, a number of studies have described an association between obesity and asthma (Fig 2).2Hancox R.J. Milne B.J. Poulton R. Taylor D.R. Greene J.M. McLachlan C.R. et al.Sex differences in the relation between body mass index and asthma and atopy in a Birth Cohort.Am J Respir Crit Care Med. 2005; 171: 440-445Crossref PubMed Scopus (213) Google Scholar, 3Wickens K. Barry D. Friezema A. Rhodius R. Bone N. Purdie G. et al.Obesity and asthma in 11-12 year old New Zealand children in 1989 and 2000.Thorax. 2005; 60: 7-12Crossref PubMed Scopus (74) Google Scholar, 4Tantisira K.G. Litonjua A.A. Weiss S.T. Fuhlbrigge A.L. Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP).Thorax. 2003; 58: 1036-1041Crossref PubMed Scopus (189) Google Scholar, 5Hedberg A. Rossner S. Body weight characteristics of subjects on asthma medication.Int J Obes Relat Metab Disord. 2000; 24: 1217-1225Crossref PubMed Scopus (30) Google Scholar, 6Guerra S. Sherrill D.L. Bobadilla A. Martinez F.D. Barbee R.A. The relation of body mass index to asthma, chronic bronchitis, and emphysema.Chest. 2002; 122: 1256-1263Crossref PubMed Scopus (286) Google Scholar, 7Chinn S. Jarvis D. Burney P. Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey.Thorax. 2002; 57: 1028-1033Crossref PubMed Scopus (176) Google Scholar In a large population of white Australian girls, a higher body mass index was reported to be a risk factor for atopy and wheeze.8Schachter L.M. Peat J.K. Salome C.M. Asthma and atopy in overweight children.Thorax. 2003; 58: 1031-1035Crossref PubMed Scopus (183) Google Scholar As a corollary, weight loss, as after bariatric surgery, has consistently been shown to improve asthma severity and control (Fig 3).9Simard B. Turcotte H. Marceau P. Biron S. Hould F.S. Lebel S. et al.Asthma and sleep apnea in patients with morbid obesity: outcome after bariatric surgery.Obes Surg. 2004; 14: 1381-1388Crossref PubMed Scopus (90) Google Scholar Changes in airway structure and function have been associated with obesity. For example, it is common to observe an atypical obese airway pattern in morbidly obese persons at bronchoscopy (Fig 4). This pattern is believed to be attributed to fat infiltration and might be responsible for airway narrowing. In regard to physiologic changes, Boulet et al10Turcotte H. Simard B. Boulay M.E. Boulet L.P. Influence of body mass index (BMI) on the effect of deep inspiration avoidance (DIA) on airway response to methacholine (M).Am J Respir Crit Care Med. 2004; 169: A246Google Scholar recently reported that obese subjects had lost the protective effect of deep inhalation to methacholine-induced bronchoconstriction that was observed in nonobese individuals (Fig 5). Fat tissue in obese persons is a source of inflammatory mediators (Table I)11Wajchenberg B.L. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome.Endocr Rev. 2000; 21: 697-738Crossref PubMed Scopus (1674) Google Scholar that might be implicated in asthma pathophysiology. Leptin is of particular interest because it has been found to be present in higher levels in obese asthmatic subjects compared with in obese nonasthmatic subjects (Fig 6).12Mai X.M. Bottcher M.F. Leijon I. Leptin and asthma in overweight children at 12 years of age.Pediatr Allergy Immunol. 2004; 15: 523-530Crossref PubMed Scopus (98) Google Scholar Leptin, an adipocyte-derived hormone, has been suggested to upregulate the inflammatory immune response. In an animal model of asthma, Shore et al13Shore S.A. Schwartzman I.N. Mellema M.S. Flynt L. Imrich A. Johnston R.A. Effect of leptin on allergic airway responses in mice.J Allergy Clin Immunol. 2005; 115: 103-109Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar recently showed that the allergen airway response is increased in the presence of leptin. They found that airway hyperresponsiveness, the number of BAL eosinophils and lymphocytes, and IL-4, IL-5, and IL-13 levels are all increased in leptin-treated animals compared with control animals. Modified with permission from Wajchenberg.12Mai X.M. Bottcher M.F. Leijon I. Leptin and asthma in overweight children at 12 years of age.Pediatr Allergy Immunol. 2004; 15: 523-530Crossref PubMed Scopus (98) Google Scholar However, despite the animal, epidemiologic, and physiologic evidence to date, there have been no reports yet of a comprehensive study that shows a substantial difference in the pathology of asthma in obese compared with nonobese patients." @default.
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