Obesity and Asthma: Intersecting Pathways and Real-World Impacts

ReachMD Announcer:
You’re listening to Clinician’s Roundtable on ReachMD. On this episode, we’ll hear from Dr. Anne Dixon, who’s a pulmonologist, professor, and the E. L. Amidon Chair of the Department of Medicine at The University of Vermont Robert Larner, M.D. School of Medicine. She’ll be sharing insights on the relationship between asthma and obesity. Here’s Dr. Dixon now.

Dr. Dixon:
There’s a really important relationship between obesity and asthma. Obesity is a major risk factor for asthma, particularly in adult women. It's associated with poor control. Patients with obesity and asthma have increased exacerbations compared with lean people, and unfortunately, people with obesity do not seem to respond as well to inhaled corticosteroids in combination therapy with long-acting beta agonists.

People with obesity and asthma do respond to biologics, but they're more likely to have persistent poor control and exacerbations even when treated appropriately with biologics. And this is not just a problem in the US; it's a problem worldwide. And it's not just a problem in adults; it's a problem in children, too.

So, a lot of people have wondered whether obesity is causing the asthma or whether asthma is worsening the obesity, it's really interesting. There are actually common genetic factors that are recognized as risk factors for both obesity and adult-onset asthma in particular. Exposure to air pollution increases your risk for asthma, but actually, it also increases your risk for developing obesity. And there's been some fascinating studies in animals that suggest that  pregnant female animals fed a high-fat diet and having metabolic dysfunction, their offspring will likely have increased airway reactivity, even if the offspring are lean and eating a healthy diet. So, we think there are epigenetic factors that can influence development of asthma.

And actually, having asthma is a risk factor for the future development of obesity. We use corticosteroids, and we certainly worry that steroids can aggravate the development of obesity. Another potential reason is that people with asthma often have a hard time breathing and don't participate in exercise, so is it reduced physical activity?

Probably, all of these things play a role. So it's genetics, epigenetics, environmental exposures, insulin resistance—it's an incredibly complicated relationship, and I think obesity and metabolic dysfunction change many many biologic processes. That's why obesity and asthma are related.

ReachMD Announcer:
That was Dr. Anne Dixon discussing how asthma and obesity are related. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!