Influence of weight loss on pulmonary function and levels of adipokines among asthmatic individuals with obesity: One-year follow-up.

BACKGROUND: Individuals with obesity are more likely to develop asthma, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the release of inflammatory mediators secreted by adipose tissue. OBJECTIVE: To assess the effects of weight loss in patients submitted to bariatric surgery on pulmonary and systemic inflammation. METHOD: The study evaluated patients undergoing bariatric surgery (Roux-en-Y gastric bypass) with the diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into a preoperative weight loss group (T1), just before bariatric surgery (T2), six months after surgery (T3), and 12 months after surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, pulmonary inflammatory markers obtained by induced sputum collection, pulmonary function parameters, and asthma activity assessed by a Asthma Control Test (ACT) questionnaire. RESULTS: Nineteen patients participated in the study. There were significant reductions in the systemic levels of interleukin (IL)-8 (p = 0.002), C-reactive protein (CRP) (p = 0.003), leptin (p = 0.001) and tumor necrosis factor (TNF)-α (p = 0.007), and significant increase in the systemic levels of IL-6 (p = 0.004) over time and adiponectin in T2 (p = 0.025). In regards to pulmonary inflammation, there were significant reductions in the sputum levels of TNF-α (p < 0.001). There was no significant improvement of the pulmonary function parameters (p > 0.05) and significant improvement in asthma activity scores (p < 0.0001). CONCLUSION: Weight loss was associated with significant changes in the systemic and pulmonary inflammatory profiles of individuals with asthma, leading to a better asthma control as a result of an increase in some anti-inflammatory mediators and a reduction of pro-inflammatory mediators.

Analysis of quality of life among asthmatic individuals with obesity and its relationship with pulmonary function: cross-sectional study.

CONTEXT AND OBJECTIVE:: The combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure its relationship with pulmonary function. DESIGN AND SETTING:: Observational cross-sectional study in public university hospital. METHODS:: Morbidly obese individuals (body mass index > 40 kg/m2) seen in a bariatric surgery outpatient clinic and diagnosed with asthma, were included. Anthropometric data were collected, the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) was applied and spirometry was performed. The subjects were divided into two groups based on the median of the score in the questionnaire (worse < 4 and better > 4) and were compared regarding anthropometric data and pulmonary function. RESULTS:: Among the 4791 individuals evaluated, 219 were asthmatic; the prevalence of asthma was 4.57%. Of these, 91 individuals were called to start multidisciplinary follow-up during the study period, of whom 82 answered the questionnaire. The median score in the AQLQ(S) was 3.96 points and, thus, the individuals were classified as having moderate impairment of their overall QOL. When divided according to better or worse QOL, there was a statistically difference in forced expiratory flow (FEF) 25-75%, with higher values in the better QOL group. CONCLUSION:: The prevalence of asthma was 4.57% and QOL was impaired among the asthmatic obese individuals. The worst QOL domain related to environmental stimuli and the best QOL domain to limitations of the activities. Worse QOL was correlated with poorer values for FEF 25-75%.

Analysis of quality of life among asthmatic individuals with obesity and its relationship with pulmonary function: cross-sectional study / Análise da qualidade de vida de indivíduos asmáticos obesos e sua relação com a função pulmonar: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: The combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure its relationship with pulmonary function. DESIGN AND SETTING: Observational cross-sectional study in public university hospital. METHODS: Morbidly obese individuals (body mass index > 40 kg/m2) seen in a bariatric surgery outpatient clinic and diagnosed with asthma, were included. Anthropometric data were collected, the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) was applied and spirometry was performed. The subjects were divided into two groups based on the median of the score in the questionnaire (worse < 4 and better > 4) and were compared regarding anthropometric data and pulmonary function. RESULTS: Among the 4791 individuals evaluated, 219 were asthmatic; the prevalence of asthma was 4.57%. Of these, 91 individuals were called to start multidisciplinary follow-up during the study period, of whom 82 answered the questionnaire. The median score in the AQLQ(S) was 3.96 points and, thus, the individuals were classified as having moderate impairment of their overall QOL. When divided according to better or worse QOL, there was a statistically difference in forced expiratory flow (FEF) 25-75%, with higher values in the better QOL group. CONCLUSION: The prevalence of asthma was 4.57% and QOL was impaired among the asthmatic obese individuals. The worst QOL domain related to environmental stimuli and the best QOL domain to limitations of the activities. Worse QOL was correlated with poorer values for FEF 25-75%.

RESUMO CONTEXTO E OBJETIVO: O efeito combinado de obesidade e asma pode levar a um comprometimento significativo da qualidade de vida (QV). O objetivo foi avaliar a prevalência de asma entre obesos, caracterizar a gravidade do comprometimento da QV e verificar sua relação com a função pulmonar. TIPO DE ESTUDO E LOCAL: Estudo transversal observacional em hospital universitário público. MÉTODOS: Foram incluídos indivíduos obesos mórbidos (indice de massa corporal > 40 kg/m2), acompanhados num ambulatório de cirurgia bariátrica e diagnosticados com asma. Foram coletados dados antropométricos e aplicado o Standardized Asthma Quality of Life Questionnaire (AQLQ (S)), bem como a espirometria. Os indivíduos foram divididos em dois grupos com base na mediana obtida no escore do questionário (pior < 4 e melhor = 4) e os grupos foram comparados aos dados antropométricos e função pulmonar. RESULTADOS: Dos 4.791 indivíduos avaliados, 219 eram asmáticos; a prevalência de asma foi de 4,57%. Destes, 91 indivíduos foram chamados para iniciar o acompanhamento multidisciplinar no período do estudo, sendo que 82 responderam ao questionário. A pontuação mediana do AQLQ (S) foi de 3,96 pontos, portanto, classificados com prejuízo moderado na QV global. Quando divididos por melhor ou pior QV, houve diferença estatística no fluxo expiratório forçado (FEF) 25-75%, com maior valor no grupo com melhor QV. CONCLUSÃO: A prevalência da asma na população estudada foi de 4,57% e há prejuízos na QV de obesos asmáticos, sendo o pior domínio de QV relacionado aos estímulos ambientais e o melhor domínio de QV relacionado às limitações das atividades. A pior QV se relacionou a piores valores de FEF 25-75%.