肥胖与哮喘：肥胖在整个2型炎症谱中引发并加重哮喘
2026/03/04
摘要
全球有超过6.5亿成年人受肥胖影响，且各年龄段和各大洲的肥胖患病率持续上升。这一趋势对哮喘有着重要影响：肥胖个体患哮喘的风险比正常人高30 - 50%，且在已确诊哮喘的患者中，肥胖现象极为普遍。在成人哮喘的临床试验和登记研究中，平均体重指数（BMI）始终在28 - 30 kg·m⁻²之间，高达70%的患者超重或肥胖。这些数据凸显了肥胖是哮喘最常见的合并症之一，且一直与哮喘控制不佳和病情加重风险增加相关。尽管肥胖相关哮喘常被描述为2型（T2）低表型，但人们越来越认识到它是一种异质性疾病，并不局限于单一表型。脂肪过多通过多种机制影响哮喘，包括脂肪因子信号传导失调、脂肪组织中固有淋巴细胞2型（ILC2） - 嗜酸性粒细胞 - 巨噬细胞串扰受损、全身性轻度炎症、代谢功能障碍以及对肺容积的机械性影响。这种多样性使诊断、内型分类和治疗分层变得复杂。因此，肥胖应被视为哮喘中可治疗的特征。通过生活方式干预、药物治疗或减肥手术减轻体重，可改善T2高和T2低哮喘患者的症状、肺功能并降低病情加重风险。重要的是，肥胖患者使用抗T2生物制剂后，病情加重情况的改善与非肥胖患者相似，不过症状和肺功能的改善情况存在差异。未来的研究应优先开展随机、安慰剂对照试验，专门评估胰高血糖素样肽 - 1（GLP - 1）和双重GLP - 1/葡萄糖依赖性促胰岛素多肽（GIP）激动剂疗法在哮喘合并肥胖患者中的疗效，并阐明肥胖如何改变炎症内型和治疗反应。
Obesity and asthma: obesity causes and aggravates asthma across the entire type-2 inflammation spectrum
Sebastian Riemann, Imke Matthys, Tania Maes, Bruno Lapauw, Guy Brusselle
Abstract
Obesity affects more than 650 million adults worldwide, with prevalence continuing to rise across all age groups and continents. This trend has important implications for asthma: individuals with obesity have a 30-50% higher risk of developing asthma, and obesity is highly prevalent among people with established disease. Mean Body Mass Index (BMI) in clinical trials and registries of adults with asthma consistently ranges from 28-30 kg·m-2, with up to 70% of patients being overweight or obese. These numbers highlight obesity as one of the most common comorbidities in asthma, consistently associated with poorer asthma control and a higher risk of exacerbations. Although obesity-associated asthma is often described as Type-2 (T2)-low phenotype, it is increasingly recognized as a heterogeneous condition not restricted to a single phenotype. Excess adiposity influences asthma through multiple mechanisms, including dysregulated adipokine signaling, impaired ILC2-eosinophil-macrophage crosstalk in adipose tissue, systemic low-grade inflammation, metabolic dysfunction, and mechanical effects on lung volumes. This diversity complicates diagnosis, endotyping, and treatment stratification. Obesity should therefore be considered a treatable trait in asthma. Weight reduction - through lifestyle interventions, pharmacotherapy, or bariatric surgery - improves symptoms, lung function, and exacerbation risk across both T2-high and T2-low asthma. Importantly, patients with obesity experience similar reductions in exacerbations with anti-T2 biologics as their lean counterparts, though improvements in symptoms and lung function are variable. Future research should prioritize randomized, placebo-controlled trials evaluating GLP-1 and dual GLP-1/GIP-agonist therapies specifically in patients with asthma and obesity, and elucidate how obesity modifies inflammatory endotypes and treatment responses.
全球有超过6.5亿成年人受肥胖影响，且各年龄段和各大洲的肥胖患病率持续上升。这一趋势对哮喘有着重要影响：肥胖个体患哮喘的风险比正常人高30 - 50%，且在已确诊哮喘的患者中，肥胖现象极为普遍。在成人哮喘的临床试验和登记研究中，平均体重指数（BMI）始终在28 - 30 kg·m⁻²之间，高达70%的患者超重或肥胖。这些数据凸显了肥胖是哮喘最常见的合并症之一，且一直与哮喘控制不佳和病情加重风险增加相关。尽管肥胖相关哮喘常被描述为2型（T2）低表型，但人们越来越认识到它是一种异质性疾病，并不局限于单一表型。脂肪过多通过多种机制影响哮喘，包括脂肪因子信号传导失调、脂肪组织中固有淋巴细胞2型（ILC2） - 嗜酸性粒细胞 - 巨噬细胞串扰受损、全身性轻度炎症、代谢功能障碍以及对肺容积的机械性影响。这种多样性使诊断、内型分类和治疗分层变得复杂。因此，肥胖应被视为哮喘中可治疗的特征。通过生活方式干预、药物治疗或减肥手术减轻体重，可改善T2高和T2低哮喘患者的症状、肺功能并降低病情加重风险。重要的是，肥胖患者使用抗T2生物制剂后，病情加重情况的改善与非肥胖患者相似，不过症状和肺功能的改善情况存在差异。未来的研究应优先开展随机、安慰剂对照试验，专门评估胰高血糖素样肽 - 1（GLP - 1）和双重GLP - 1/葡萄糖依赖性促胰岛素多肽（GIP）激动剂疗法在哮喘合并肥胖患者中的疗效，并阐明肥胖如何改变炎症内型和治疗反应。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Eur Respir J. 2026 Feb 19:2502687. doi: 10.1183/13993003.02687-2025.）
（Eur Respir J. 2026 Feb 19:2502687. doi: 10.1183/13993003.02687-2025.）
Obesity and asthma: obesity causes and aggravates asthma across the entire type-2 inflammation spectrum
Sebastian Riemann, Imke Matthys, Tania Maes, Bruno Lapauw, Guy Brusselle
Abstract
Obesity affects more than 650 million adults worldwide, with prevalence continuing to rise across all age groups and continents. This trend has important implications for asthma: individuals with obesity have a 30-50% higher risk of developing asthma, and obesity is highly prevalent among people with established disease. Mean Body Mass Index (BMI) in clinical trials and registries of adults with asthma consistently ranges from 28-30 kg·m-2, with up to 70% of patients being overweight or obese. These numbers highlight obesity as one of the most common comorbidities in asthma, consistently associated with poorer asthma control and a higher risk of exacerbations. Although obesity-associated asthma is often described as Type-2 (T2)-low phenotype, it is increasingly recognized as a heterogeneous condition not restricted to a single phenotype. Excess adiposity influences asthma through multiple mechanisms, including dysregulated adipokine signaling, impaired ILC2-eosinophil-macrophage crosstalk in adipose tissue, systemic low-grade inflammation, metabolic dysfunction, and mechanical effects on lung volumes. This diversity complicates diagnosis, endotyping, and treatment stratification. Obesity should therefore be considered a treatable trait in asthma. Weight reduction - through lifestyle interventions, pharmacotherapy, or bariatric surgery - improves symptoms, lung function, and exacerbation risk across both T2-high and T2-low asthma. Importantly, patients with obesity experience similar reductions in exacerbations with anti-T2 biologics as their lean counterparts, though improvements in symptoms and lung function are variable. Future research should prioritize randomized, placebo-controlled trials evaluating GLP-1 and dual GLP-1/GIP-agonist therapies specifically in patients with asthma and obesity, and elucidate how obesity modifies inflammatory endotypes and treatment responses.
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成人哮喘患者的小气道功能障碍与缓解：哮喘小气道受累评估（ATLANTIS）研究的纵向探索性分析
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产前暴露于母体哮喘和哮喘药物与神经发育结局：179024名儿童的人群队列研究
