Discussion
obesity, exertional breathlessness, difficult-to-treat asthma, obesity-associated asthma, UC, overweight, asthma, CWP, weight loss
OBESITY, ASTHMA
In this pragmatic open-label, randomized, controlled trial, we showed that delivery of a supported low-calorie total diet replacement program (Counterweight-Plus) to patients with difficult-to-treat asthma and obesity was safe and led to significant improvements in asthma control and quality of life compared with UC over 16 weeks. We demonstrated clinically significant improvements in favor of CWP for ACQ6 score, AQLQ score overall, and symptoms, activity, and environmental AQLQ domains. Comparison by percentage total body weight loss showed that > 10% loss is needed to gain clinically relevant benefits, although loss of > 15% likely imparts greater benefit. In addition, CWP showed favorable impacts on exertional breathlessness and anthropometric measures, the latter likely to have important consequences for other aspects of general health. These findings suggest that conservative treatment targeting substantial weight loss in patients with difficult-to-treat asthma and obesity is safe and can impact patient-centered outcomes favorably. Longer-term outcomes are awaited to determine whether benefits persist. This program can be administered in a primary care setting.A small number of trials have evaluated the impact of weight loss interventions in the population with obesity-associated asthma, with varying methodologies and outcomes. Freitas et alConversely, a study of 330 participants (of 2,022 screened) reported by Ma et alScott et alÖzbey et alGrandi Silva et alThis trial has several possible limitations. This proof-of-concept feasibility study was sufficient to detect significant effects, but a larger study is needed to generate definitive results. Small differences were observed between groups at baseline (age, peak expiratory flow rate, FEVLonger-term follow-up is required to determine whether weight loss is maintained and whether asthma-related benefits persist. Additionally, a future trial with a greater sample size is justified to generate definitive results. Further research should explore the factors associated with successful treatment outcome and efficacy in the overweight (BMI, 25.0-29.9 kg/m