哮喘联盟

   摘要
   越来越多的文献表明，肥胖对哮喘的风险、基因表型和预后有明显的影响。流行病学研究已明确肥胖患者发生哮喘的可能性更大，肥胖的哮喘患者更易有健康受损，症状更多，生活质量更低，同时医疗保健投入增加且哮喘严重程度更差。然而，肥胖已被研究证实会影响肺功，以及导致呼吸困难的机制，但不会改变哮喘的病理生理。除了评估这种关联所面临的挑战外，一些研究也未能证明在成年哮喘患者中肥胖和气道炎症传统生物标记之间的明确关系，这导致得出哮喘不一定加重哮喘气道炎症的结论。就这一点而言，最新的数据表明非特应性机制可能与肥胖哮喘患者相关，这种机制可能直接影响肥胖哮喘患者对哮喘治疗，尤其是吸入糖皮质激素的反应。本文将选择性的回顾肥胖相关性气道和系统性炎症对哮喘的影响，强调肥胖作为可变风险，对预后和哮喘治疗反应的影响。
 

（苏楠 审校）
Ann N Y Acad Sci. 2014 Feb 12. doi: 10.1111/nyas.12357. [Epub ahead of print]


 

Linking obesity and asthma.
 

Sutherland ER.
 

Abstract
A growing body of literature suggests that obesity has a significant impact on asthma risk, phenotype, and prognosis. Epidemiological studies have clearly demonstrated that asthma is more likely to occur in obese patients, and health status is impaired in obese individuals with asthma, with obese asthmatics experiencing more symptoms, worse quality of life, increased healthcare use, and increased asthma severity. However, obesity has well-described effects on lung function and mechanics that can lead to symptoms of dyspnea without causing the pathophysiologic changes of asthma. Adding to the challenges of evaluating this association, some studies have failed to demonstrate a robust relationship between obesity and traditional biomarkers of airway inflammation in adult asthmatics, leading to the conclusion that obesity does not necessarily worsen airway inflammation in asthma. In this regard, emerging data suggest that nonatopic mechanisms may be relevant in obese asthmatics, and that these mechanisms may have a direct impact on the response of obese asthmatics to asthma therapies, most notably inhaled glucocorticoids. This article will review selected aspects of the contributions of obesity-related airway and systemic inflammation to asthma, with a focus on the impact of obesity as a modifier of risk, prognosis, and therapeutic response in asthma.
 

Ann N Y Acad Sci. 2014 Feb 12. doi: 10.1111/nyas.12357. [Epub ahead of print