The Woolcock Institute of Medical Research, Cooperative Research Centre for Asthma and Airways, Glebe, and The University of Sydney, Sydney, New South Wales, Australia.
Respirology. 2012 Apr;17(3):412-21. doi: 10.1111/j.1440-1843.2011.02080.x.
The obese asthma phenotype is an increasingly common encounter in our clinical practice. Epidemiological data indicate that obesity increases the prevalence and incidence of asthma, and evidence that obesity precedes the development of asthma raises the possibility of a causal association. Obese patients with asthma experience more symptoms and increased morbidity compared with non-obese asthma patients. Despite more than a decade of research into this association, the exact mechanisms that underlie the interaction of obesity with asthma remain unclear. It is unlikely that the asthma-obesity association is simply due to comorbidities such as obstructive sleep apnoea or gastroesophageal reflux disease. Although inflammatory pathways are purported to play a role, there is scant direct evidence in humans that systemic inflammation modulates the behaviour of the asthmatic airway or the expression of symptoms in the obese. The role of non-eosinophilic airway inflammation also requires further study. Obesity results in important changes to the mechanical properties of the respiratory system, and these obesity-related factors appear to exert an additive effect to the asthma-related changes seen in the airways. An understanding of the various physiological perturbations that might be contributing to symptoms in obese patients with asthma will allow for a more targeted and rational treatment approach for these patients.
肥胖型哮喘表型在我们的临床实践中越来越常见。流行病学数据表明，肥胖症会增加哮喘的患病率和发病率，而肥胖症先于哮喘发展的证据则提出了一种因果关系的可能性。与非肥胖型哮喘患者相比，肥胖型哮喘患者的症状更多，发病率更高。尽管对这种关联进行了十多年的研究，但肥胖与哮喘相互作用的确切机制仍不清楚。肥胖症与哮喘之间的关联不太可能仅仅是由于阻塞性睡眠呼吸暂停或胃食管反流病等合并症所致。尽管炎症途径被认为发挥了作用，但在人类中几乎没有直接证据表明全身炎症会调节哮喘气道的行为或肥胖者的症状表达。非嗜酸性气道炎症的作用也需要进一步研究。肥胖症会导致呼吸系统力学特性发生重要变化，而这些与肥胖相关的因素似乎会对气道中观察到的与哮喘相关的变化产生附加影响。了解可能导致肥胖型哮喘患者出现症状的各种生理变化，将为这些患者提供更有针对性和更合理的治疗方法。
