1 - Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de São José;
2 - Centro Clínico Académico de Lisboa;
3 - Serviço de Imunoalergologia, Unidade Local de Saúde de São José;
4 - Comprehensive Health Research Center(CHRC), NOVA Medical School, Universidade Nova de Lisboa, Portugal
- Póster no 74º Congresso da Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo, fevereiro 2024, Albufeira
Resumo:
Introduction: Obesity and asthma are common chronic conditions that share a pathogenesis of inflammation. There is a bidirectional complex relationship, with asthma being more common in obese individuals and obesity being an important asthma comorbidity. Obese patients tend to have a more severe and difficult to control asthma, suggesting that it can be considered a distinct asthma phenotype. Inadequate asthma control may lead to reduced exercise tolerance and higher need for inhaled or even oral corticosteroid therapy, increasing the risk of obesity.
Objectives: To evaluate the impact of obesity in adults with asthma.
Material and methods: A subgroup analysis was conducted within an observational, cross-sectional study at an Allergy and Immunology department in a tertiary hospital. Adult patients with a clinical diagnosis of asthma were included. Data collection involved a standardized questionnaire, lung function tests and clinical file analysis. Comorbidities were considered based on personal history. Assessment criteria encompassed the Asthma Control Test (ACT), asthma severity as per GINA 2023, fractional exhaled nitric oxide (FeNO) for airway inflammation, and the risk of sleep-related breathing disorders using the Berlin Questionnaire. Patients were categorized into two groups: those with obesity (Body Mass Index ≥ 30Kg/m2) and those without obesity (<30 Kg/m2).
Results: Among the 213 included patients, the majority were female (70.0%, n=149) with a median age (interquartile range) of 29 (24) years. Twenty-one percent (n=45) were classified in the “with obesity” group, with 42 (93.3%) sensitized to at least one aeroallergen. Patients with asthma and obesity exhibited significantly more comorbidities related to metabolic syndrome, namely high blood pressure (33.3% vs 4.2%, p<.001), diabetes mellitus (11.1% vs 0.6%, p<.001) and dyslipidemia (35.6% vs 6.5%, p<.001). Patients with asthma and obesity showed worse asthma control (ACT≥20: 62.2% vs 81.5%, p=.006), higher severity (GINA step≥3: 86.7% vs 71.4%, p=.037), higher risk of sleep apnea (73.3% vs 8.3%, p<.001) and higher airway inflammation (FeNO≥25: 33.3% vs 17.9%, p=.044).
Conclusions: Our analysis revealed a significant negative impact of obesity in asthma control and severity and an association with higher airway inflammation. The presence of metabolic dysfunction and higher risk of sleep apnea in this group may also affect asthma management. Poor asthma control can make weight loss difficult to achieve, highlighting the importance for clinicians to be aware of assessing the presence of asthma in individuals with obesity, and refer for proper evaluation and treatment by allergists.
Palavras Chave: asma, obesidade, controlo de asma