Forno Erick, Celedón Juan C
Division of Pulmonary Medicine, Allergy, and Immunology, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
Curr Opin Allergy Clin Immunol. 2017 Apr;17(2):123-130. doi: 10.1097/ACI.0000000000000339.
There is ample and growing evidence that obesity increases the risk of asthma and morbidity from asthma. Here, we review recent clinical evidence supporting a causal link between obesity and asthma, and the mechanisms that may lead to 'obese asthma'.
Although in some children obesity and asthma simply co-occur, those with 'obese asthma' have increased asthma severity, lower quality of life, and reduced medication response. Underlying mechanistic pathways may include anatomical changes of the airways such as obstruction and dysanapsis, systemic inflammation, production of adipokines, impaired glucose-insulin metabolism, altered nutrient levels, genetic and epigenetic changes, and alterations in the airway and/or gut microbiome. A few small studies have shown that weight loss interventions may lead to improvements in asthma outcomes, but thus far research on therapeutic interventions for these children has been limited.
Obesity increases the risk of asthma - and worsens asthma severity or control - via multiple mechanisms. 'Obese asthma' is a complex, multifactorial phenotype in children. Obesity and its complications must be managed as part of the treatment of asthma in obese children.
有充分且不断增加的证据表明，肥胖会增加患哮喘的风险以及哮喘导致的发病率。在此，我们综述近期支持肥胖与哮喘之间存在因果关系的临床证据，以及可能导致“肥胖性哮喘”的机制。
虽然在一些儿童中肥胖和哮喘只是同时出现，但患有“肥胖性哮喘”的儿童哮喘严重程度增加、生活质量降低且药物反应减弱。潜在的机制途径可能包括气道的解剖学改变，如阻塞和不匹配、全身炎症、脂肪因子的产生、葡萄糖 - 胰岛素代谢受损、营养水平改变、遗传和表观遗传变化，以及气道和/或肠道微生物群的改变。一些小型研究表明，减肥干预可能会改善哮喘结局，但迄今为止，针对这些儿童的治疗干预研究有限。
肥胖通过多种机制增加哮喘风险，并使哮喘严重程度恶化或控制情况变差。“肥胖性哮喘”是儿童中一种复杂的多因素表型。肥胖及其并发症必须作为肥胖儿童哮喘治疗的一部分加以管理。
