Obesity and asthma.
Obesity and asthma.
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DOI：
10.1513/annalsats.201302-038aw
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发表时间：
2013-12-01
影响因子：
8.3
通讯作者：
Gibson, Peter G
中科院分区：
文献类型：
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作者：
Gibson, Peter G
哮喘和肥胖是一种全球性的流行病，主要集中在西方化和发达国家。在一些哮喘患者中，肥胖先于哮喘发作，并且对病态肥胖进行减肥手术可以缓解哮喘，这表明两者之间存在因果关系。肥胖哮喘表型的特点是哮喘控制不佳，对皮质类固醇的反应有限，肥胖对肺功能的生理影响夸大，包括呼气储备量减少和潮汐呼吸时发生的气道关闭。肥胖对哮喘治疗具有重要意义。根据目前指南的建议，在哮喘控制不佳的情况下增加皮质类固醇剂量可能导致肥胖哮喘患者过度使用皮质类固醇。支气管扩张的增强，特别是小气道的扩张，可能由于支气管运动性张力的增加而减少气道关闭的成分，这表明在肥胖哮喘中应该更加重视长效支气管扩张药。这对社会的影响是重要的：随着肥胖的增加，肥胖引起的哮喘也会增加，确定成功的个人和社会体重控制策略的必要性成为一个关键目标。
There is a global epidemic of asthma and obesity that is concentrated in Westernized and developed countries. A causal association in some people with asthma is suggested by observations that obesity precedes the onset of asthma and that bariatric surgery for morbid obesity can resolve asthma. The obese asthma phenotype features poor asthma control, limited response to corticosteroids, and an exaggeration of the physiological effects of obesity on lung function, which includes a reduction in expiratory reserve volume and airway closure occurring during tidal breathing. Obesity has important implications for asthma treatment. Increasing corticosteroid doses based on poor asthma control, as currently recommended in guidelines, may lead to overtreatment with corticosteroids in obese asthma. Enhanced bronchodilation, particularly of the small airways, may reduce the component of airway closure due to increased bronchomotor tone and suggests that greater emphasis should be placed on long-acting bronchodilators in obese asthma. The societal implications of this are important: with increasing obesity there will be increasing asthma from obesity, and the need to identify successful individual and societal weight-control strategies becomes a key goal.