Airway inflammation in obese and nonobese patients with difficult-to-treat asthma
Airway inflammation in obese and nonobese patients with difficult-to-treat asthma
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DOI：
10.1111/j.1398-9995.2007.01597.x
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发表时间：
2008-05-01
期刊：
影响因子：
12.4
通讯作者：
Bel, E. H.
中科院分区：
文献类型：
--
作者：
van Veen, I. H.;ten Brinke, A.;Bel, E. H.
背景：哮喘和肥胖是相关疾病，但肥胖对难治性哮喘的影响以及造成这种关系的机制尚不清楚。本研究的目的是调查难治性哮喘患者的肥胖（体重指数 >= 30）与哮喘严重程度相关因素之间的关系。方法：对 136 名非吸烟哮喘成人进行了研究，尽管他们服用高剂量吸入或口服皮质类固醇和长效支气管扩张剂，但症状仍持续[70% 为女性，中位年龄（范围）为 44.6 (18-75) 岁，32% 每天口服皮质类固醇]。肥胖、肺功能参数[1秒用力呼气量(FEV1)、功能残气量/肺总量(FRC/TLC)]、炎症标志物[血嗜酸性粒细胞、痰嗜酸性粒细胞和中性粒细胞、呼出一氧化氮(FENO)、气道高反应性、C反应蛋白(CRP)]和加重共病因素(严重慢性结果：与非肥胖患者 (n = 107) 相比，肥胖患者 (n = 29) 的 FEV1%pred 较高 (P = 0.05)，FRC/TLC%pred 较低 (P < 0.01)。体重指数与痰嗜酸性粒细胞（r = -0.36，P < 0.01）和FENO（r = -0.30，P < 0.01）呈负相关。肥胖患者胃食管反流（OR = 2.3）和睡眠呼吸暂停（OR = 3.1）的风险增加。结论：难治性哮喘患者的肥胖与痰嗜酸性粒细胞和FENO呈负相关，与共病因素的存在和肺容量减少呈正相关。这表明，除了气道炎症之外，还有其他因素可以解释肥胖与哮喘严重程度之间的关系。
Background: Asthma and obesity are associated disorders, but the contribution of obesity to difficult-to-treat asthma as well as the mechanisms responsible for this relationship are unclear. The aim of this study was to investigate the relationship between obesity (body mass index >= 30) and factors related with asthma severity in patients with difficult-to-treat asthma.Methods: One hundred and thirty-six nonsmoking asthmatic adults with persistent symptoms despite high doses of inhaled or oral corticosteroids and long-acting bronchodilators were studied [70% female, median (range) age 44.6 (18-75) years, 32% on daily oral corticosteroids]. The association between obesity, lung function parameters [forced expiratory volume in 1 s (FEV1), functional residual capacity/total lung capacity (FRC/TLC)], inflammatory markers [blood eosinophils, sputum eosinophils and neutrophils, exhaled nitric oxide (FENO), airway hyperresponsiveness, C-reactive protein (CRP)] and aggravating co-morbid factors (severe chronic sinus disease, gastro-esophageal reflux, recurrent respiratory infections, psychopathology and obstructive sleep apnea) was investigated.Results: Obese patients (n = 29) had a higher FEV1%pred (P = 0.05) and a lower FRC/TLC%pred (P < 0.01) compared with nonobese patients (n = 107). Body mass index was inversely related with sputum eosinophils (r = -0.36, P < 0.01) and FENO (r = -0.30, P < 0.01). Obese patients had an increased risk for gastro-esophageal reflux (OR = 2.3) and sleep apnea (OR = 3.1).Conclusion: Obesity in patients with difficult-to-treat asthma is inversely related with sputum eosinophils and FENO, and positively associated with the presence of co-morbid factors and reduced lung volumes. This suggests that other factors than airway inflammation alone explain the relationship between obesity and asthma severity.