1. OBESITY AND ASTHMA Dr. Enrico Heffler (enrico_heffler@yahoo.it) MD, Specialist in Allergy and Clinical Immunology Allergy and Clinical Immunology - University of Torino (Italy) Allergy Outpatients’ Clinic- “E.Agnelli” Hospital - Pinerolo (Italy) Allergy Outpatients’ Clinic – Valenza, Casale Monferrato and Acqui Terme Hospitals (Italy)

2. OBESITY DEFINITION: * Excessive fat in body tissues. * The National Heart, Lung and Blood Institute (NHLBI) defines overweight as having a body mass index (BMI) of 25 to 29.9 and obese as having a BMI of 30 or greater.

3. OBESITY AS A RISK FACTOR: * Obesity increases the risk of developing many health conditions: OBESITY

4. INCREASING PREVALENCE IN WESTERN COUNTRIES: England 16-64 yrs. USA 20-74 yrs. Former E. Germany 25-65 yrs. W. Samoa (urban) 25-69 yrs. Japan 20+ yrs. Brazil 25-64 yrs. 19821987 1993 1975 1989 1980 1966 1991 1995 19731978 1991 1985 1989 1992 1978 1991 19821987 1993 1975 1989 1980 1966 1991 1995 19731978 1991 1985 1989 1992 1978 1991 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 - 0 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 - 0 Women Men Prevalence of obesity (%) OBESITY

5. INCREASING PREVALENCE IN WESTERN COUNTRIES: USA 1990 – 2004: OBESITY

6. INCREASING PREVALENCE IN WESTERN COUNTRIES: UK 1987 – 2004: OBESITY

7. INCREASING PREVALENCE IN WESTERN COUNTRIES: OBESITY

8. ASTHMA INCREASING PREVALENCE IN WESTERN COUNTRIES:

9. OBESITY & ASTHMA EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA: * Studies have shown 1.5-3-0 fold increase in prevalence of asthma amongst obese patients.

10. OBESITY & ASTHMA Beuther DA & Sutherland ER – Overweight, obesity, and incident asthma. A meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med 2007;175:661.666

11. OBESITY & ASTHMA Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010

12. OBESITY & ASTHMA EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA: * Studies have shown 1.5-3-0 fold increase in prevalence of asthma amongst obese patients. * Weight gain is associated with incident cases of asthma.

13. 86.000 US registered nurses (age 26-46) who were free of asthma at the start of the study followed for 4 years. Analysis of 1596 new asthma diagnosis between 1991-95. “ The Nurses Health Study “ OBESITY & ASTHMA Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588

14. “ The Nurses Health Study “ OBESITY & ASTHMA Camargo CA et al – Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch Internal Med 1999;159:2582-2588

15. OBESITY & ASTHMA Hjellvik V et al – Body mass index as predictor for asthma: a cohort study of 118723 men and women – BMJ 2010

16. OBESITY & ASTHMA EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA: * Studies have shown 1.5-3-0 fold increase in prevalence of asthma amongst obese patients. * Weight gain is associated with incident cases of asthma. * Weight loss is associated with improved asthma outcomes.

17. Stenius-Aarniala B et al. – Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000 OBESITY & ASTHMA

18. EVIDENCE OF ASSOCIATION BETWEEN OBESITY AND ASTHMA: * Studies have shown 1.5-3-0 fold increase in prevalence of asthma amongst obese patients. * Weight gain is associated with incident cases of asthma. * Weight loss is associated with improved asthma outcomes. * There is particularly compelling association between obesity and more severe asthma, particularly in females.

19. Distribution of BMI among adults presenting to the ED with acute asthma. Thomson CC et al. Chest 2003;124:795-802 OBESITY & ASTHMA

20. Thomsen SF et al. – Association between obesity and asthma in a twin cohort. Allergy 2007;62:1199-1204

21. Chen Y et al et al – The association between obesity and asthma is stronger in non-allergic than allergic adults. Chest 2006 OBESITY & ASTHMA

22. MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA: OBESITY & ASTHMA

23. MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA: OBESITY & ASTHMA

24. MECHANISMS OF THE LINK BETWEEN OBESITY AND ASTHMA: OBESITY & ASTHMA

25. Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008 AsthmaticsControls RESPONSE TO INHALED CORTICOSTEROIDS:

26. OBESITY & ASTHMA Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008

27. OBESITY & ASTHMA AsthmaticsControls Sutherland RE et al – Body mass and glucocorticoid response in asthma – Am J Respir Crit Care Med 2008

28. RESPONSE TO INHALED CORTICOSTEROIDS: * Obese patients with asthma seem to have a predominant sputum neutrophilia (“noneosinophilic asthma”) associated to more severe asthma Reduced response to inhaled corticosteroids therapy? * We retrospectively studied 42 patients with asthma who had undergone assessment of airway function and inflammation before and two months after treatment with inhalebudesonide 400 mcg twice daily (Green et al. - Analysis of induced sputum in adults with asthma. Thorax 2002; 57(10):875-879) OBESITY & ASTHMA Heffler E, Green RH, Brightling C and Pavord ID – submitted

29. PATIENTS & METHODS PATIENTS: * 42 patients (23 males; 19 females) with asthma diagnosed in accordance with the current international guidelines STUDY DESIGN: * Potential predictive factors: BMI, age, gender, atopy, eosinophils and neutrophils differential cell counts in induced sputum * Response parameters: methacoline PC 20 FEV 1, sputum eosinophils, symptoms VAS and FEV 1 Heffler E, Green RH, Brightling C and Pavord ID – submitted

30. RESULTS THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI: Heffler E, Green RH, Brightling C and Pavord ID – submitted

31. RESULTS THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI: Heffler E, Green RH, Brightling C and Pavord ID – submitted

32. RESULTS THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN BASELINE AND POST-THERAPY DATA COMPARING PATIENTS GROUPED BY BMI: Heffler E, Green RH, Brightling C and Pavord ID – submitted

33. CONCLUSIONS * Our data are in agreement with a paper by Peters-Golden et al. (Eur Resp J 2006) in which the response to treatment with inhaled beclomethasone was not affected by BMI * The link between obesity and asthma is a hot topic in respiratory research and needs further investigations in order to clarify the consistency of it consistency of it Heffler E, Green RH, Brightling C and Pavord ID – submitted

34. OBESITY & ASTHMA MYTH or REALITY?