Ridolo Erminia, Ottoni Martina, Nicoletta Francesca, Locatelli Francesca, Martinelli Luigi, Maule Matteo, Cheema Naila Arif, Blasi Francesco, Paggiaro Pierluigi, Heffler Enrico, Brussino Luisa, Canonica Giorgio Walter, Senna Gianenrico, Caminati Marco
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
World Allergy Organ J. 2025 May 5;18(5):101056. doi: 10.1016/j.waojou.2025.101056. eCollection 2025 May.
Asthma and obesity are both chronic diseases. Obesity is a common comorbidity and a risk factor of severe asthma, associated with increased asthma exacerbation risk, poorer asthma control and reduced quality of life. However, the responsible mechanisms are poorly understood. The aim of this study was to detect parameters associated with obesity in patients with severe asthma in order to check different pattern of inflammation in obese asthmatics. Baseline data from the Severe Asthma Network in Italy (SANI) registry were analysed in 1922 patients with severe asthma. Demographic, clinical and functional features were compared, according to body mass index (BMI). The prevalence of overweight and obesity among severe asthma patients was 34,8 and 20,3, respectively. Females were more prevalent in the obese cluster (p < 0.001). Asthma onset age in overweight and obese patients was higher than in normal population (p < 0.001). Obese subjects reported less frequently chronic rhinosinusitis with nasal polyposis (CRSwNP) and more frequently impaired sleep quality, cardiovascular disease, and type-2 diabetes (p < 0.001). Severe asthma patients with obesity had lower predicted FVC values (89.0 ± 19.2 vs 93.5 ± 20.2; p 0.002) and higher FEV1/FVC ratio (69.9 ± 11.5 vs 66.9 ± 12.4; p < 0.001) than patients without obesity. Obese asthmatics had lower blood eosinophilic count, and fractional exhaled nitric oxide (FeNO) levels than non-obese asthmatics. Asthma control test (ACT) was significantly poorer in obese patients (17, IQR 12-21) than other subgroups. Regarding treatment, overweight and obese patients were more likely to receive a GINA-Step 5 therapy (p 0.023), with more than 20 of obese asthmatics having frequent exacerbations requiring oral corticosteroid (OCS). Patients with severe asthma and obesity presented different characteristics that support the existence of distinct asthma phenotype in obese patients.
Trial registry: ClinicalTrials.gov. ID: NCT06625216. Retrospectively registered October 3, 2024.
哮喘和肥胖都是慢性疾病。肥胖是一种常见的合并症，也是重度哮喘的一个危险因素，与哮喘急性加重风险增加、哮喘控制不佳以及生活质量下降有关。然而，其相关机制尚不清楚。本研究的目的是检测重度哮喘患者中与肥胖相关的参数，以检查肥胖哮喘患者不同的炎症模式。对意大利重度哮喘网络（SANI）登记处的1922例重度哮喘患者的基线数据进行了分析。根据体重指数（BMI）比较了人口统计学、临床和功能特征。重度哮喘患者中超重和肥胖的患病率分别为34.8%和20.3%。肥胖组中女性更为常见（p<0.001）。超重和肥胖患者的哮喘发病年龄高于正常人群（p<0.001）。肥胖受试者慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的报告频率较低，而睡眠质量受损、心血管疾病和2型糖尿病的报告频率较高（p<0.001）。与无肥胖的患者相比，重度肥胖哮喘患者的预测用力肺活量（FVC）值较低（89.0±19.2 vs 93.5±20.2；p=0.002），第一秒用力呼气容积/用力肺活量（FEV1/FVC）比值较高（69.9±11.5 vs 66.9±12.4；p<0.001）。肥胖哮喘患者的血液嗜酸性粒细胞计数和呼出一氧化氮分数（FeNO）水平低于非肥胖哮喘患者。肥胖患者的哮喘控制测试（ACT）明显比其他亚组差（17，四分位间距12 - 21）。在治疗方面，超重和肥胖患者更有可能接受全球哮喘防治创议（GINA）第5步治疗（p=0.023），超过20%的肥胖哮喘患者频繁急性加重，需要口服糖皮质激素（OCS）。重度哮喘合并肥胖的患者表现出不同的特征，支持肥胖患者中存在独特的哮喘表型。
试验注册机构：ClinicalTrials.gov。标识符：NCT06625216。2024年10月3日追溯注册。
