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• W2046261627 abstract "Obesity is a risk factor for the development of asthma. The United States and much of the world are experiencing an unprecedented epidemic of obesity, and so it is estimated that obesity may be responsible for 250,000 new cases of asthma per year in the United States.1Beuther DA Sutherland ER Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies.Am J Respir Crit Care Med. 2007; 175: 661-666Crossref PubMed Scopus (801) Google Scholar Not only is obesity a risk factor for asthma, but asthma in the obese has distinct features compared to disease in the nonobese. Obese asthmatics tend to have more severe disease,2Taylor B Mannino D Brown C et al.Body mass index and asthma severity in the National Asthma Survey.Thorax. 2008; 63: 14-20Crossref PubMed Scopus (234) Google Scholar, 3Mosen DM Schatz M Magid DJ et al.The relationship between obesity and asthma severity and control in adults.J Allergy Clin Immunol. 2008; 122 (e506): 507-511Abstract Full Text Full Text PDF PubMed Scopus (250) Google Scholar respond less well to standard controller therapy,4Peters-Golden M Swern A Bird SS et al.Influence of body mass index on the response to asthma controller agents.Eur Respir J. 2006; 27: 495-503Crossref PubMed Scopus (353) Google Scholar and have evidence of cellular glucocorticoid resistance,5Sutherland ER Goleva E Strand M et al.Body mass and glucocorticoid response in asthma.Am J Respir Crit Care Med. 2008; 178: 682-687Crossref PubMed Scopus (252) Google Scholar this despite the fact they do not appear to have worsened airway inflammation as measured by either sputum eosinophils or neutrophils.6Lessard A Turcotte H Cormier Y et al.Obesity and asthma: a specific phenotype?.Chest. 2008; 134: 317-323Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar Asthma in the obese represents a growing epidemic of pulmonary disease, and these patients are distinct from nonobese asthmatics. Accordingly, studies on the pathogenesis of asthma in the obese are critical to guide our understanding of this disease process; such studies will ultimately guide the development of new therapies to treat the obese asthmatic population. Mechanical factors are certainly involved in the pathogenesis of this disease. The obese breathe at low lung volumes, and breathing at low lung volumes increases bronchial hyperreactivity.7Ding DJ Martin JG Macklem PT Effects of lung volume on maximal methacholine-induced bronchoconstriction in normal humans.J Appl Physiol. 1987; 62: 1324-1330Crossref PubMed Scopus (17) Google Scholar Salome et al8Salome CM Munoz PA Berend N et al.Effect of obesity on breathlessness and airway responsiveness to methacholine in non-asthmatic subjects.Int J Obes (Lond). 2008; 32: 502-509Crossref PubMed Scopus (78) Google Scholar have also shown that the obese have increased dyspnea from bronchoconstriction related to increased elastic load, which could contribute to symptoms in the obese. Mechanical factors are likely to be very important in the pathogenesis and clinical presentation of asthma in the obese. However, asthma in the obese is not simply a mechanical phenomenon. Shore9Shore SA Obesity and asthma: lessons from animal models.J Appl Physiol. 2007; 102: 516-528Crossref PubMed Scopus (126) Google Scholar showed that obese mice have increased airway hyperreactivity (independent of lung volume), and also increased airway hyperreactivity and inflammation in response to ozone. Obese people have similar enhanced responses to ozone.10Alexeeff SE Litonjua AA Suh H et al.Ozone exposure and lung function: effect modified by obesity and airways hyperresponsiveness in the VA normative aging study.Chest. 2007; 132: 1890-1897Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar There appear to be nonmechanical factors that contribute to asthma in the obese; these other factors include mediators produced by adipose tissue. Adipose tissue is not simply a passive storage organ but is a complex metabolically active tissue, with important endocrine and immune functions.11Ferrante Jr, AW Obesity-induced inflammation: a metabolic dialogue in the language of inflammation.J Intern Med. 2007; 262: 408-414Crossref PubMed Scopus (416) Google Scholar Adipose tissue produces a number of mediators, termed adipokines, which have significant metabolic effects. One of these adipokines, adiponectin, is actually decreased in the obese. Adiponectin has antiinflammatory properties: low adiponectin levels have been associated with accelerated atherosclerosis and increased metabolic stress.12Hug C Lodish HF The role of the adipocyte hormone adiponectin in cardiovascular disease.Curr Opin Pharmacol. 2005; 5: 129-134Crossref PubMed Scopus (105) Google Scholar Low adiponectin levels have also been associated with asthma in population studies.13Sood A Cui X Qualls C et al.Association between asthma and serum adiponectin concentration in women.Thorax. 2008; 63: 877-882Crossref PubMed Scopus (108) Google Scholar, 14Nagel G Koenig W Rapp K et al.Associations of adipokines with asthma, rhinoconjunctivitis, and eczema in German schoolchildren.Pediatr Allergy Immunol. 2008 March 7; ([Epub ahead of print])PubMed Google Scholar The relevance of adiponectin to asthma may not be immediately obvious, but Shore et al15Shore SA Terry RD Flynt L et al.Adiponectin attenuates allergen-induced airway inflammation and hyperresponsiveness in mice.J Allergy Clin Immunol. 2006; 118: 389-395Abstract Full Text Full Text PDF PubMed Scopus (250) Google Scholar have shown that adiponectin infusion can decrease airway hyperreactivity in a mouse model of allergic asthma. Not only that, but allergen challenge decreases adiponectin levels in adipose tissue and serum15Shore SA Terry RD Flynt L et al.Adiponectin attenuates allergen-induced airway inflammation and hyperresponsiveness in mice.J Allergy Clin Immunol. 2006; 118: 389-395Abstract Full Text Full Text PDF PubMed Scopus (250) Google Scholar; therefore, in mice, low adiponectin may both contribute to and be a result of allergic asthma. This has not previously been studied in humans but is an important issue. If low adiponectin levels are the result of allergic asthma, this represents an interesting link between the lung and adipose tissue; but if low adiponectin levels could be involved in the pathogenesis of asthma, this suggests potential opportunity for intervention in obese asthmatics. Sood et al16Sood A Qualls C Seagraves J et al.Effect of specific allergen inhalation on serum adiponectin in human asthma.Chest. 2009; 135: 287-294Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar performed a meticulous translational study, reported in this issue of CHEST (see page 287), in which the investigators performed a specific antigen challenge in a group of allergic asthmatics; serum adiponectin was measured in the 24 h following this challenge. They were unable to find any decrease in serum adiponectin over this 24-h period, although, overall, asthmatics did have lower adiponectin levels than nonasthmatics. This suggests that lower adiponectin levels in asthmatics are likely not the result of asthma, at least acutely, but leave open the possibility that low adiponectin could be contributing to the pathogenesis of asthma. Given the current epidemic of obesity, and the evidence that these patients represent a unique phenotype with more severe asthma unresponsive to standard controller therapy, we need to better understand the pathogenesis of asthma in the obese. This will require mechanistic studies on the role of adipokines on the lung, and meticulous interventional studies to determine if modulation of these factors could improve lung disease in this patient population. The study by Sood et al16Sood A Qualls C Seagraves J et al.Effect of specific allergen inhalation on serum adiponectin in human asthma.Chest. 2009; 135: 287-294Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar represents the first step in understanding the role of adiponectin in humans with asthma. The next question that needs to be addressed is whether modulation of adiponectin could affect disease activity in obese people with asthma." @default.
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• W2046261627 title "Adipokines and Asthma" @default.
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