Bates Jason H T
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont.
Am J Respir Cell Mol Biol. 2016 May;54(5):618-23. doi: 10.1165/rcmb.2016-0019PS.
Obesity affects the incidence and severity of asthma in at least two major phenotypes: an early-onset allergic (EOA) form that is complicated by obesity and a late-onset nonallergic (LONA) form that occurs only in the setting of obesity. Both groups exhibit airway hyperresponsiveness to methacholine challenge but exhibit differential effects of weight loss. Measurements of lung function in patients with LONA obese asthma suggest that this group of individuals may simply be those unlucky enough to have airways that are more compliant than average, and that this leads to airway hyperresponsiveness at the reduced lung volumes caused by excess adipose tissue around the chest wall. In contrast, the frequent exacerbations in those with EOA obese asthma can potentially be explained by episodic inflammatory thickening of the airway wall synergizing with obesity-induced reductions in lung volume. These testable hypotheses are based on the strong likelihood that LONA and EOA obese asthma are distinct diseases. Both, however, may benefit from targeted therapeutics that impose elevations in lung volume.
一种是早发性过敏性（EOA）哮喘，肥胖会使其病情复杂化；另一种是迟发性非过敏性（LONA）哮喘，仅在肥胖情况下发生。两组患者对乙酰甲胆碱激发试验均表现出气道高反应性，但体重减轻的影响有所不同。对LONA肥胖型哮喘患者的肺功能测量表明，这群人可能只是运气不佳，其气道比一般人更易扩张，这导致在胸壁周围过多脂肪组织引起的肺容积减小情况下出现气道高反应性。相比之下，EOA肥胖型哮喘患者频繁发作可能是由于气道壁的间歇性炎症增厚与肥胖引起的肺容积减小共同作用所致。这些可检验的假设基于LONA和EOA肥胖型哮喘很可能是不同疾病这一观点。然而，两者可能都受益于能增加肺容积的靶向治疗方法。
