Phase 3 Study of Reslizumab in Patients With Poorly Controlled Asthma: Effects Across a Broad Range of Eosinophil Counts. Normocaloric Diet Improves Asthma-Related Quality of Life in Obese Pubertal Adolescents Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids A Multifactorial Weight Reduction Programme for Children with Overweight and Asthma: A Randomized Controlled Trial Clinical predictors of remission and persistence of adult‐onset asthma Cluster analysis and clinical asthma phenotypes. Effects of weight loss on asthma control in obese patients with severe asthma Confirmation of asthma in an era of overdiagnosis A comparison of obese and nonobese people with asthma: exploring an asthma-obesity interaction. Comorbid diseases in aspirin-exacerbated respiratory disease, and asthma. Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Overdiagnosis of asthma in obese and nonobese adults Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Predictors of accelerated decline in lung function in adult-onset asthma Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. The Role of Exercise in a Weight‐Loss Program on Clinical Control in Obese Adults with Asthma. A Randomized Controlled Trial Diet-Induced Weight Loss in Obese Children With Asthma: A Randomized Controlled Trial Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma A large subgroup of mild-to-moderate asthma is persistently noneosinophilic.
BACKGROUND IL-5 , a mediator of eosinophil activity , is an important potential treatment target in patients with uncontrolled asthma . The efficacy of reslizumab , a humanized anti-human IL-5 monoclonal antibody , has been characterized in patients with blood eosinophils ≥ 400 cells/μL. This study further characterizes the efficacy and safety of reslizumab in patients with poorly-controlled asthma , particularly those with eosinophils < 400 cells/μL. METHODS Patients were r and omly assigned to intravenous reslizumab 3.0 mg/kg or placebo once every 4 weeks for 16 weeks . The primary end point was the change in FEV1 from baseline to week 16 . Secondary measures included Asthma Control Question naire-7 ( ACQ-7 ) scores , use of short-acting β-agonists ( SABAs ) , and FVC . RESULTS Four hundred ninety-two patients received ≥ 1 dose of placebo ( n = 97 ) or reslizumab ( n = 395 ) . In the overall population , mean FEV1 change from baseline to week 16 was not significantly different between reslizumab and placebo , and no significant relationship was detected between treatment , baseline blood eosinophils and change in FEV1 . In the subgroup of patients with baseline eosinophils < 400 cells/μL , patients treated with reslizumab showed no significant improvement in FEV1 compared with those receiving placebo . In the subgroup with eosinophils ≥ 400 cells/μL , however , treatment with reslizumab was associated with much larger improvements in FEV1 , ACQ-7 , rescue SABA use , and FVC compared with the placebo group . Reslizumab was well tolerated , with fewer overall adverse events compared with placebo ( 55 % vs 73 % ) . CONCLUSIONS Reslizumab was well tolerated in patients with inadequately controlled asthma . Clinical ly meaningful effects on lung function and symptom control were not seen in patients unselected for baseline eosinophils . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01508936 ; URL : www . clinical trials.gov Background : Restrictive , very low-energy diets focused on rapid weight loss have proven to be effective in improving asthma outcome in obese patients , but their use in children and pubescents is controversial due its potential consequences in growth . More conservative , normocaloric schemes are suggested as a more suitable dietary approach for these patients . Methods : A r and omized clinical trial was run of 51 pubertal adolescents with asthma and obesity , who were allocated to either an  interventional 28-week  program  of normocaloric diet based on normal requirements for height and meal planning ( n = 26 ) or a non-interventional ( free diet ) control group ( n = 25 ) . Asthma-related quality of life ( AR-QOL , assessed by the St and ardized Pediatric Asthma Quality of Life Question naire , PAQLQ[S ] ) and clinical indicators of asthma control were measured before and after the intervention period . Results : Diet intervention was associated with a significant improvement in AR-QOL in relation to baseline ( Δ PAQLQ[S ] scores ) compared with controls , both in overall score ( p < 0.001 ) and its subdomains ( activity limitation , p < 0.001 ; symptoms , p < 0.002 ; emotional function , p < 0.001 ) . The group with normocaloric diet observed a significant decrease in body mass index z-score , which correlated positively with the improvement in AR-QOL ( Spearman 's r = 0.51 , p < 0.01 ) , in addition to have significantly fewer events of acute attacks of asthma and nighttime awakenings , plus a non-significant reduction in the use of inhaled corticosteroids . No significant changes were observed in the pulmonary function tests . Conclusion : The normocaloric dietary intervention was associated with improvement of AR-QOL and some aspects of asthma control . Such structured dietary programs could probably have a role as a complementary non-pharmacological therapeutic strategy in obese pubertal adolescents with asthma Background : Overweight/obesity ( OW ) is linked to worse asthma and poorer inhaled corticosteroid ( ICS ) response in older children and adults . Objective : We sought to describe the relationships between OW and asthma severity and response to ICS  in preschool children . Methods : This post hoc study of 3 large multicenter trials involving 2‐ to 5‐year‐old children compared annualized asthma symptom days and exacerbations among normal weight ( NW ) ( body mass index : 10th‐84th percentiles ) versus OW ( body mass index : ≥85th percentile ) participants . Participants had been r and omized to daily ICS , intermittent ICS , or daily placebo .  Simple and multivariable linear regression was used to compare body mass index groups . Results : Within the group not treated with a daily controller , OW children had more asthma symptom days ( 90.7 vs 53.2 , P = .020 ) and exacerbations ( 1.4 vs 0.8 , P = .009 ) thanNW children did . Within the ICS‐treated groups , OW and NW children had similar asthma symptom days ( daily ICS : 47.2 vs 44.0 days , P = .44 ; short‐term ICS : 61.8 vs 52.9 days , P = .46 ; as‐needed ICS : 53.3 vs 47.3 days , P = .53 ) , and similar exacerbations ( daily ICS : 0.6 vs 0.8 , P = .10 ; short‐term ICS : 1.1 vs 0.8 days , P = .25 ; as‐needed ICS : 1.0 vs 1.1 , P = .72 ) . Compared with placebo , daily ICS in OW led to fewer annualized asthma symptom days ( 90.7 vs 41.2 , P = .004 ) and exacerbations ( 1.4 vs 0.6 , P = .006 ) , while similar protective ICS effects were less apparent among NW . Conclusions : In preschool children off controller therapy , OW is associated with greater asthma impairment and exacerbations . However , unlike older asthmatic patients , OW preschool children do not demonstrate reduced responsiveness to ICS therapy Background There is increasing evidence that obesity is related to asthma development and severity . However , it is largely unknown whether weight reduction can influence asthma management , especially in children . Objective To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with ( a high risk of developing ) asthma . Methods An 18-month weight-reduction r and omized controlled trial was conducted in 87 children with overweight/obesity and asthma . Every six months , measurements of anthropometry , lung function , lifestyle parameters and inflammatory markers were assessed . Analyses were performed with linear mixed models for longitudinal analyses . Results After 18 months , the body mass index-st and ard deviation score decreased by -0.14±0.29 points ( p<0.01 ) in the intervention group and -0.12±0.34 points ( p<0.01 ) in the control group . This change over time did not differ between groups ( p>0.05 ) . Asthma features ( including asthma control and asthma-related quality of life ) and lung function indices ( static and dynamic ) improved significantly over time in both groups . The FVC% predicted improved over time by 10.1 ± 8.7 % in the intervention group ( p<0.001 ) , which was significantly greater than the 6.1 ± 8.4 % in the control group ( p<0.05 ) . Conclusions & clinical relevance Clinical ly relevant improvements in body weight , lung function and asthma features were found in both the intervention and control group , although some effects were more pronounced in the intervention group ( FVC , asthma control , and quality of life ) . This implies that a weight reduction intervention could be clinical ly beneficial for children with asthma . Trial Registration Clinical Trials.gov Background : Adult‐onset asthma is an important but relatively understudied asthma phenotype and little is known about its natural course and prognosis . The remission rate is believed to be low , and it is still obscure which factors predict remission or persistence of the disease . Objective : This study sought to determine the remission rate and identify predictors of persistence and remission of adult‐onset asthma . Methods : Two hundred adult patients with recently diagnosed ( < 1 year ) asthma were recruited from secondary and tertiary pulmonary clinics and prospect ively followed for 5 years . Clinical , functional , and inflammatory parameters were assessed at baseline and at yearly visits . Asthma remission was defined as absence of asthma symptoms for ≥1 year and no asthma medication use for ≥1 year . Descriptive statistics and logistic regression analysis were performed . Results : Five‐year follow‐up data of 170 patients ( 85 % ) was available . Of these , 27 patients ( 15.9 % ) experienced asthma remission . Patients with asthma persistence were older , had worse asthma control , required higher doses of inhaled corticosteroids , had more severe airway hyperresponsiveness , more often nasal polyps , and higher levels of blood neutrophils as compared to patients who experienced clinical remission . In a multivariable logistic regression analysis , only moderate to severe bronchial hyperresponsiveness and nasal polyps were independent predictors of asthma persistence . Patients with these 2 characteristics had < 1 % chance of asthma remission . Conclusions : One in 6 patients with adult‐onset asthma  experiences remission within the first 5 years of the disease . In patients with moderate to severe bronchial hyperresponsiveness and nasal polyposis , the chance of remission is close to zero RATIONALE Heterogeneity in asthma expression is multidimensional , including variability in clinical , physiologic , and pathologic parameters . Classification requires consideration of these disparate domains in a unified model . OBJECTIVES To explore the application of a multivariate mathematical technique , k-means cluster analysis , for identifying distinct phenotypic groups . METHODS We performed k-means cluster analysis in three independent asthma population s. Clusters of a population managed in primary care ( n = 184 ) with predominantly mild to moderate disease , were compared with a refractory asthma population managed in secondary care ( n = 187 ) . We then compared differences in asthma outcomes ( exacerbation frequency and change in corticosteroid dose at 12 mo ) between clusters in a third population of 68 subjects with predominantly refractory asthma , clustered at entry into a r and omized trial comparing a strategy of minimizing eosinophilic inflammation ( inflammation-guided strategy ) with st and ard care . MEASUREMENTS AND MAIN RESULTS Two clusters ( early-onset atopic and obese , noneosinophilic ) were common to both asthma population s. Two clusters characterized by marked discordance between symptom expression and eosinophilic airway inflammation ( early-onset symptom predominant and late-onset inflammation predominant ) were specific to refractory asthma . Inflammation-guided management was superior for both discordant subgroups leading to a reduction in exacerbation frequency in the inflammation-predominant cluster ( 3.53 [ SD , 1.18 ] vs. 0.38 [ SD , 0.13 ] exacerbation/patient/yr , P = 0.002 ) and a dose reduction of inhaled corticosteroid in the symptom-predominant cluster ( mean difference , 1,829 mug beclomethasone equivalent/d [ 95 % confidence interval , 307 - 3,349 mug ] ; P = 0.02 ) . CONCLUSIONS Cluster analysis offers a novel multidimensional approach for identifying asthma phenotypes that exhibit differences in clinical response to treatment algorithms Studies on the effects of weight loss in patients with asthma are scarce . No studies have been performed in patients with severe asthma . Therefore , the aim of the present study was to assess the impact of weight loss  in patients with severe asthma associated with obesity . This was an open , prospect i ve , r and omised study of two parallel groups , in patients with severe uncontrolled asthma and moderate obesity . The primary outcome was the level of asthma control 6 months after initiation of the  weight reduction programme  , quantified using the Asthma Control Question naire ( ACQ ) . We evaluated clinical parameters , lung function , markers of airway inflammation and circulating cytokines .  22 patients were r and omised to undergo treatment for obesity and 11 to the control group .  The weight reduction programme was associated with significant improvements in asthma control ( mean±se ACQ score 3.02±0.19 to 2.25±0.28 in the treatment group versus 2.91±0.25 to 2.90±0.16 in the controls , p=0.001 ) . This improvement was not accompanied by changes in markers of airway inflammation or bronchial reactivity , but by an increase in forced vital capacity . Our results suggest  that weight reduction in obese patients with severe asthma improves asthma outcomes by mechanisms not related to airway inflammation . Weight loss improves outcomes in severely asthmatic obese patients ; poor control results from obesity-related factors It was recently shown that 30 % of adults with a physician diagnosis of asthma did not have asthma when objective ly assessed using a four-step algorithm involving serial spirometry , bronchial challenge testing and subsequent tapering of asthma medications . The objective of the present study was to determine how many steps in the algorithm were required in order to confirm asthma , and whether any patient-related variables were associated with earlier asthma confirmation . A total of 540 subjects with a previous physician diagnosis of asthma were r and omly recruited from the community . The number of subjects confirmed with asthma at each study visit was calculated . Regression analysis was used to determine variables associated with earlier asthma confirmation . Of the 499 subjects who completed the diagnostic algorithm , 346 ( 69 % ) had asthma confirmed and 150 ( 30 % ) had asthma excluded . Of subjects in whom asthma was confirmed , including those using regular asthma controlling medications , > 90 % were confirmed with only one or two study visits , by either pre- and post-bronchodilator spirometry or a single bronchial challenge test . Only 46 ( 9 % ) out of 499 subjects required tapering of asthma medications and repeated bronchial challenge tests for exclusion or confirmation of asthma . Lower forced expiratory volume in 1 s and younger age were associated with earlier asthma confirmation . For the majority with a previous physician diagnosis of asthma , only pre- and post-bronchodilator spirometry and a single methacholine challenge test are required in order to confirm asthma OBJECTIVE The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma , including potential interactions with obesity . METHODS We r and omly selected patients with physician-diagnosed asthma from eight Canadian cities . Asthma diagnosis was confirmed via a sequential lung function testing algorithm . Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma . Interaction with obesity was investigated . RESULTS Complete assessment s were obtained on 496 subjects who reported physician-diagnosed asthma ( 242 obese and 254 normal-weight subjects ) ; 346 had asthma confirmed with sequential lung testing , and in 150 subjects a diagnosis of asthma was ruled out . Obese subjects with asthma were significantly more likely to be men , have a history of hypertension and gastroesophageal reflux disease , and have a lower FEV(1 ) compared with normal-weight subjects with asthma . Older subjects , men , and subjects with higher FEV(1 ) were more likely to have received misdiagnoses of asthma . Obesity was not an independent predictor of misdiagnosis , however there was an interaction between obesity and urgent visits for respiratory symptoms . The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 ( 95 % CI , 1.23 - 13.5 ) for those with urgent visits in the past 12 months . CONCLUSIONS Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma . Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma BACKGROUND Asthma , persistent rhinosinusitis , and /or nasal polyposis accompanying non-steroidal anti-inflammatory drug ( NSAID ) intolerance is defined as aspirin-exacerbated respiratory disease ( AERD ) . Although the literature includes considerable data on comorbidities in asthma , data on comorbidities in AERD have not been previously published . OBJECTIVE This study aim ed to determine the prevalence of comorbidities in AERD and compare the findings to those in asthmatic patients . MATERIAL S AND METHODS The records for 330 AERD patients that presented to our allergy clinic were review ed . Patients with urticaria/angio-oedema type reactions to NSAIDs were included in the pseudo Samter 's group ( n=83 ) and 338 r and omly selected NSAID-tolerant asthma patients constituted the control group . RESULTS Gender , age at presentation , age at onset of asthma , and follow-up periods were similar in all groups . Hypertension ( P=0.035 ) , diabetes mellitus ( P=0.323 ) , gastro-oesophageal reflux ( P<0.001 ) , psychological disorders ( P=0.099 ) , obesity ( P=0.003 ) , and hyperlipidaemia ( P=0.002 ) were significantly more prevalent in the asthma group . Interestingly , coronary artery disease ( CAD ) and congestive heart failure ( CHF ) were more common in the AERD group ( P=0.178 ) ; CAD/CHF was associated with AERD ( OR : 4.5 ; 95 % CI : 1.206 - 16.93 ) . CONCLUSION AERD and asthma are associated with several comorbidities . Even though systemic steroid dependency and severe asthma were significantly more common in the AERD group , comorbidities occurred more frequently in the asthma group . Additional longitudinal studies are needed to more clearly discern if the risk of CAD/CHF is increased in AERD BACKGROUND Obesity is a risk factor for self-reported asthma and makes asthma management more difficult . The effects of bariatric surgery on asthma in severely obese subjects remain to be documented . METHODS In this prospect i ve study , 12 asthmatic patients with severe obesity were evaluated before , 6 and 12 months after bariatric surgery .  Each had methacholine inhalation tests , measures of expiratory flows and lung volumes , measurements of C-reactive protein and question naires on asthma medication , asthma symptoms and co-morbid conditions . Eleven severely obese patients with asthma ( considered as controls ) underwent the same evaluations . Primary endpoint was airway responsiveness to methacholine and secondary endpoints were lung volumes and markers of systemic inflammation . RESULTS Mean body mass index decreased from 51.2 to 34.4 kg/m(2 ) twelve months post-surgery . Mean PC(20 ) methacholine improved from 0.84 to 6.2 mg/ml ( P < 0.001 ) ; FEV(1 ) , FVC , FRC , FRC/TLC and ERV all improved ( P ≤ 0.006 ) . C-reactive protein decreased from 8.6 to 1.7 mg/L ( P < 0.001 ) Asthma symptoms total score was significantly reduced ( P = 0.03 ) and asthma medication needs decreased , ten patients being able to stop all asthma drugs . No significant changes of these parameters from baseline were observed in asthmatic controls . Improvements in airway responsiveness and lung volumes happened in parallel and correlated with reductions of body mass index ( r = 0.58 , P = 0.049 ) , C-reactive protein levels ( r = -0.74 , P = 0.004 ) . CONCLUSION Airway responsiveness , lung volumes and asthma severity/control markedly improved with weight loss following bariatric surgery in severely obese patients Background : It is unclear whether asthma is overdiagnosed in developed countries , particularly among obese individuals , who may be more likely than nonobese people to experience dyspnea . Methods : We conducted a longitudinal study involving nonobese ( body mass index 20–25 ) and obese ( body mass index ≥ 30 ) individuals with asthma that had been diagnosed by a physician . Participants were recruited from 8 Canadian cities by means of r and om-digit dialing . A diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms , reversible airflow obstruction or bronchial hyperresponsiveness , despite being weaned off asthma medications . We stopped asthma medications in those in whom a diagnosis of asthma was excluded and assessed their clinical outcomes over 6 months . Results : Of 540 individuals with physician-diagnosed asthma who participated in the study , 496 ( 242 obese and 254 nonobese ) could be conclusively assessed for a diagnosis of asthma . Asthma was ultimately excluded in 31.8 % ( 95 % confidence interval [ CI ] 26.3%–37.9 % ) in the obese group and in 28.7 % ( 95 % CI 23.5%–34.6 % ) in the nonobese group . Overdiagnosis of asthma was no more likely to occur among obese individuals than among nonobese individuals ( p = 0.46 ) . Of those in whom asthma was excluded , 65.5 % did not need to take asthma medication or seek health care services because of asthma symptoms during a 6-month follow-up period . Interpretation : About one-third of obese and nonobese individuals with physician-diagnosed asthma did not have asthma when objective ly assessed . This finding suggests that , in developed countries such as Canada , asthma is overdiagnosed BACKGROUND Obesity and asthma are common disorders , and their prevalence rates continue to rise . Although individuals with asthma may gain weight as a result of activity limitations , the relationship between body mass index ( BMI ) , which is calculated as weight in kilograms divided by the square of height in meters , and risk of developing asthma is not known . METHODS We performed a prospect i ve cohort study of female US registered nurses in the Nurses ' Health Study II . In 1991 , after excluding women who died with probable asthma or with incomplete data , there were 85911 participants , aged 26 to 46 years . The main outcome measure was self-report of physician-diagnosed asthma with recent use of an asthma medication . RESULTS From 1991 to 1995 , we identified 1596 incident cases of asthma . In a multivariate model controlling for 9 potential confounding factors ( including age , race , smoking , physical activity , and energy intake ) , the relative risks of asthma for 6 increasing categories of BMI in 1991 were 0.9 , 1.0 ( reference ) , 1.1 , 1.6 , 1.7 , and 2.7 ( P for trend < .001 ) . Stronger associations were found using stricter definitions for asthma , and the finding was present in a variety of subgroups . In analyses controlling for the same variables , as well as BMI at age 18 , women who gained weight after age 18 were at significantly increased risk of developing asthma during the 4-year follow-up period ( P for trend < .001 ) . CONCLUSIONS The BMI has a strong , independent , and positive association with risk of adult-onset asthma . The increasing prevalence of obesity in developed nations may help explain concomitant increases in asthma prevalence Little is known about the prognosis of adults with new-onset asthma . Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s ( FEV1 ) . However , risk factors for accelerated decline in lung function have not yet been identified . We aim ed to identify these risk factors in a prospect i ve 5-year follow-up study in 200 adults with newly diagnosed asthma . In the current study , clinical , functional and inflammatory parameters were assessed annually for 5 years . Linear mixed-effects models were used to identify predictors . Evaluable lung function sets of 141 patients were available .  Median ( interquartile range ) change in post-bronchodilator FEV1 was −17.5 ( −54.2 to + 22.4 ) mL per year . Accelerated decline in FEV1 was defined by the lower quartile of decline ( > 54.2 mL per year ) . Nasal polyps , number of blood and sputum eosinophils , body mass index , and level of exhaled nitric oxide were univariably associated with decline in lung function . Only the latter two were independently associated . Using cut-off values to identify patients at highest risk showed accelerated decline in FEV1 in all patients with combined exhaled nitric oxide fraction ( FeNO ) ≥57 ppb and body mass index ( BMI ) ≤23 kg·m−2 . We conclude that adults with new-onset asthma with both high levels of exhaled nitric oxide and low BMI are at risk of accelerated decline in lung function . Exhaled nitric oxide and BMI predict accelerated decline in FEV1 in adults with new-onset asthma BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach Rationale : Clinical control is difficult to achieve in obese patients with asthma .  Bariatric surgery has been recommended for weight loss and to improve asthma control ; however , the benefits of nonsurgical interventions have been poorly investigated . Objectives : To examine the effect of exercise training in a weight‐loss program on asthma control , quality of life , inflammatory biomarkers , and lung function . Methods : Fifty‐five obese patients with asthma were r and omly assigned to either a weight‐loss program plus exercise ( WL + E group , n = 28 ) or a weight‐loss program plus sham ( WL + S group , n = 27 ) , where the weight‐loss program included nutrition ( caloric restriction ) and psychological therapies . The WL + E group incorporated aerobic and resistance muscle training , whereas the WL + S group incorporated breathing and stretching exercises . Measurements and Main Results : The primary outcome was clinical improvement in asthma control over 3 months . Secondary outcomes included quality of life , lung function , body composition , aerobic capacity , muscle strength , and inflammatory/antiinflammatory biomarkers . After 3 months , 51 patients were analyzed . Compared with the WL + S group , the WL + E group demonstrated improved clinical control scores ( median [ 25th to 75th percentile ] , −0.7 [ −1.3 to −0.3 ] vs. −0.3 [ −0.9 to 0.4 ] ; P = 0.01 ) and greater weight loss ( mean ± SD , −6.8 % ± 3.5 vs. −3.1 % ± 2.6 ; P < 0.001 ) and aerobic capacity ( median [ 25th to 75th percentile ] , 3.0 [ 2.4 to 4.0 ] vs. 0.9 [ −0.3 to 1.3 ] ml O2 × kg−1 × min−1 ; P < 0.001 ) . These improvements in the WL + E group were also accompanied by improvements in lung function , antiinflammatory biomarkers , and vitamin D levels , as well as reductions in airway and systemic inflammation . Conclusions : Adding exercise to a short‐term weight‐loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients . Clinical trial registered with www . clinical trials.gov ( NCT 02188940 ) ME Jensen , PG Gibson , CE Collins , JM Hilton , LG Wood . Clin Exp Allergy . 2013;43(7):775–784 The goal of this study was to assess if dietary intervention ( DI ) can achieve weight loss in obese asthmatic children and if diet-induced weight loss leads to changes in asthma outcomes . The study evaluated 32 obese ( BMI z score ≥1.64 SD score ) Australian children aged 8 to 17 years , with a physician diagnosis of asthma . Exclusion criteria included unexplained weight change during the past 3 months , inflammatory or endocrine disorders , and respiratory disorders other than asthma . In this 10-week , r and omized controlled trial , 32 obese asthmatic children were r and omized to Importance Although asthma is a chronic disease , the expected rate of spontaneous remissions of adult asthma and the stability of diagnosis are unknown . Objective To determine whether a diagnosis of current asthma could be ruled out and asthma medications safely stopped in r and omly selected adults with physician-diagnosed asthma . Design , Setting , and Participants A prospect i ve , multicenter cohort study was conducted in 10 Canadian cities from January 2012 to February 2016 . R and om digit dialing was used to recruit adult participants who reported a history of physician-diagnosed asthma established within the past 5 years . Participants using long-term oral steroids and participants unable to be tested using spirometry were excluded . Information from the diagnosing physician was obtained to determine how the diagnosis of asthma was originally made in the community . Of 1026 potential participants who fulfilled eligibility criteria during telephone screening , 701 ( 68.3 % ) agreed to enter into the study . All participants were assessed with  home peak flow and symptom monitoring , spirometry , and serial bronchial challenge tests  , and those participants using daily asthma medications had their medications gradually tapered off over 4 study visits . Participants in whom a diagnosis of current asthma was ultimately ruled out were followed up clinical ly with repeated bronchial challenge tests over 1 year . Exposure Physician-diagnosed asthma established within the past 5 years . Main Outcomes and Measures The primary outcome was the proportion of participants in whom a diagnosis of current asthma was ruled out , defined as participants who exhibited no evidence of acute worsening of asthma symptoms , reversible airflow obstruction , or bronchial hyperresponsiveness after having all asthma medications tapered off and after a study pulmonologist established an alternative diagnosis . Secondary outcomes included the proportion with asthma ruled out after 12 months and the proportion who underwent an appropriate initial diagnostic workup for asthma in the community . Results Of 701 participants ( mean [ SD ] age , 51 [ 16 ] years ; 467 women [ 67 % ] ) , 613 completed the study and could be conclusively evaluated for a diagnosis of current asthma . Current asthma was ruled out in 203 of 613 study participants ( 33.1 % ; 95 % CI , 29.4%-36.8 % ) . Twelve participants ( 2.0 % ) were found to have serious cardiorespiratory conditions that had been previously misdiagnosed as asthma in the community . After an additional 12 months of follow-up , 181 participants ( 29.5 % ; 95 % CI , 25.9%-33.1 % ) continued to exhibit no clinical or laboratory evidence of asthma . Participants in whom current asthma was ruled out , compared with those in whom it was confirmed , were less likely to have undergone testing for airflow limitation in the community at the time of initial diagnosis ( 43.8 % vs 55.6 % , respectively ; absolute difference , 11.8 % ; 95 % CI , 2.1%-21.5 % ) . Conclusions and Relevance Among adults with physician-diagnosed asthma , a current diagnosis of asthma could not be established in 33.1 % who were not using daily asthma medications or had medications weaned . In patients such as these , reassessing the asthma diagnosis may be warranted RATIONALE Airway eosinophilia is typical of asthma , and many controller treatments target eosinophilic disease . Asthma is clinical ly heterogeneous , however , and a subgroup of people with asthma do not have airway eosinophilia . The size of this subgroup is uncertain because prior studies have not examined repeated measures of sputum cytology to determine when people with asthma have intermittent versus persistent sputum eosinophila and when they are persistently noneosinophilic . OBJECTIVES To determine the prevalence and clinical characteristics of the noneosinophilic asthma phenotype . METHODS We analyzed  sputum cytology  data from 995 subjects with asthma enrolled in clinical trials in the Asthma Clinical Research Network where they had undergone sputum induction and measures of sputum cytology  , often repeatedly , and assessment of responses to st and ardized asthma treatments . MEASUREMENTS AND MAIN RESULTS In cross-sectional analyses , sputum eosinophilia ( ≥2 % eosinophils ) was found in only 36 % of subjects with asthma not taking an inhaled corticosteroid ( ICS ) and 17 % of ICS-treated subjects with asthma ; an absence of eosinophilia was noted frequently , even in subjects with asthma whose disease was suboptimally controlled . In repeated measures analyses of people with asthma not taking an ICS , 22 % of subjects had sputum eosinophilia on every occasion ( persistent eosinophilia ) ; 31 % had eosinophilia on at least one occasion ( intermittent eosinophilia ) ; and 47 % had no eosinophilia on every occasion ( persistently noneosinophilic ) . Two weeks of combined antiinflammatory therapy caused significant improvements in airflow obstruction in eosinophilic asthma , but not in persistently noneosinophilic asthma . In contrast , bronchodilator responses to albuterol were similar in eosinophilic and noneosinophilic asthma . CONCLUSIONS Approximately half of patients with mild-to-moderate asthma have persistently noneosinophilic disease , a disease phenotype that responds poorly to currently available antiinflammatory therapy
Obesity is an asthma common comorbidity and is associated not only with its development , but also with a poorer control and higher severity of it .
Recent prospect i ve evidence supports the idea that body weight gain precedes the development of asthma , but the debate is far from over .
The objective of this document is to conduct a systematic review of 3 clinical questions related to asthma and obesity : 1 .
Obesity and asthma : the chicken or the egg ?
Clinical insights from epidemiological and phenotypes studies .
2 .
Is obesity a confounding factor in the diagnosis and management of asthma and especially in severe or difficult-to-control asthma ?
3 .
How obese asthma subjects respond to pharmacological treatments , and to biological drugs ?
Do we have effective specific interventions ? .