Obesity Is a Determinant of Asthma Control Independent of Inflammation and Lung Mechanics
Obesity Is a Determinant of Asthma Control Independent of Inflammation and Lung Mechanics
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DOI：
10.1378/chest.11-0027
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发表时间：
2011-09-01
期刊：
影响因子：
9.6
通讯作者：
Salome, Cheryl M.
中科院分区：
文献类型：
--
作者：
Farah, Claude S.;Kermode, Jessica A.;Salome, Cheryl M.
背景：尚不清楚为什么肥胖与哮喘控制较差有关。我们假设 (1) 肥胖影响哮喘控制，与肺活量测定、气道炎症和气道高反应性 (AHR) 无关，并且 (2) 炎症消退后的残留症状是由于肥胖相关的肺力学变化所致。方法：49 名哮喘受试者在接受大剂量吸入皮质类固醇 (ICS) 治疗 3 个月之前和之后接受了以下测试：五项哮喘控制问卷 (ACQ-5)、肺量测定、哮喘分数呼出一氧化氮 (FENO)、乙酰甲胆碱挑战和强迫振荡技术，可计算呼吸系统阻力 (Rrs) 和呼吸系统电抗 (Xrs)，分别作为气道口径和弹性负荷的指标。使用方差分析按 BMI 组（18.5-24.9、25-29.9 和 >= 30 kg/m(2)）评估治疗效果。多元回归分析确定了 ACQ-5 结果的独立预测因子。结果：在基线时，ACQ-5 结果的独立预测因子是 FEV1、FENO 和 BMI（模型 r(2) = 0.38，P < .001）。治疗后，BMI 组的哮喘控制、肺活量测定、气道炎症和 AHR 都有类似的改善。治疗后 ACQ-5 结果的独立预测因子是 Rrs 和 BMI（模型 r(2) = 0.42，P < .001）。结论：BMI 是哮喘控制的决定因素，独立于气道炎症、肺功能和 AHR。 ICS 治疗后，BMI 再次预测 ACQ-5 结果，但与肥胖相关的肺力学变化无关。胸部 2011； 140(3):659-666
Background: It is unclear why obesity is associated with worse asthma control. We hypothesized that (1) obesity affects asthma control independent of spirometry, airway inflammation, and airway hyperresponsiveness (AHR) and (2) residual symptoms after resolution of inflammation are due to obesity-related changes in lung mechanics.Methods: Forty-nine subjects with asthma underwent the following tests, before and after 3 months of high-dose inhaled corticosteroid (ICS) treatment: five-item asthma control questionnaire (ACQ-5), spirometry, fraction of exhaled nitric oxide (FENO), methacholine challenge, and the forced oscillation technique, which allows for the calculation of respiratory system resistance (Rrs) and respiratory system reactance (Xrs) as indicators of airway caliber and elastic load, respectively. The effects of treatment were assessed by BMI group (18.5-24.9, 25-29.9, and >= 30 kg/m(2)) using analysis of variance. Multiple regression analyses determined the independent predictors of ACQ-5 results.Results: At baseline, the independent predictors of ACQ-5 results were FEV1, FENO, and BMI (model r(2) = 0.38, P < .001). After treatment, asthma control, spirometry, airway inflammation, and AHR improved similarly across BMI groups. The independent predictors of ACQ-5 results after treatment were Rrs and BMI (model r(2) = 0.42, P < .001).Conclusions: BMI is a determinant of asthma control independent of airway inflammation, lung function, and AHR. After ICS treatment, BMI again predicts ACQ-5 results, but independent of obesity-related changes in lung mechanics. CHEST 2011; 140(3):659-666