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Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I).

Abstract

BACKGROUND

Asthma and obesity are chronic multifactorial conditions that are associated with gene-environment interaction and immune function. Although the data are not fully consistent, it seems that obesity increases the risk of asthma and compromises asthma control.

OBJECTIVE

To investigate the impact that weight changes have on asthma.

METHODS

We carried out a systematic review of three large biomedical databases. Studies were scrutinized and critically appraised according to agreed exclusion and inclusion criteria. Quality assessment of eligible papers was conducted using the GRADE method. Meta-analyses of comparable studies were carried out.

RESULTS

Thirty studies met the eligibility criteria of the review. Interventions were limited to dietary manipulation in three studies, one of which also used anti-obesity drugs, and bariatric surgery in four. All the other studies reported observational data. Becoming obese increased the odds for incident asthma by 1.82 (95% CI 1.47, 2.25) in adults and 1.98 (95% CI 0.71, 5.52) in children. Weight loss was associated with significant improvement in mean scores for symptoms, rescue medication score, and asthma exacerbations in the only randomized controlled trial. Similarly, evidence gathered from observational studies, with follow-up ranging between 8 weeks to 1 year, and from changes 1 year after bariatric surgery showed improvements in all asthma control-related outcomes. Changes in lung function were reported in one randomized controlled and eight observational studies of asthmatic subjects, with conflicting results. Either improvement after weight loss, decline with weight gain, or no effects at all were reported. Changes in airway inflammation and responsiveness were reported only by observational studies.

CONCLUSION

Weight increases above the obesity threshold significantly increase the risk of asthma. The available studies show weak evidence of benefits from weight reduction on asthma outcomes.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Faculty of Medicine, University of Porto and Hospital São João, Porto, Portugal. andremoreira@med.up.pt

    , , , , , , , , ,

    Source

    Allergy 68:4 2013 Apr pg 425-39

    MeSH

    Asthma
    Evidence-Based Medicine
    Humans
    Incidence
    Obesity
    Weight Loss

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Systematic Review

    Language

    eng

    PubMed ID

    23452010

    Citation

    Moreira, A, et al. "Weight Loss Interventions in Asthma: EAACI Evidence-based Clinical Practice Guideline (part I)." Allergy, vol. 68, no. 4, 2013, pp. 425-39.
    Moreira A, Bonini M, Garcia-Larsen V, et al. Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I). Allergy. 2013;68(4):425-39.
    Moreira, A., Bonini, M., Garcia-Larsen, V., Bonini, S., Del Giacco, S. R., Agache, I., ... Haahtela, T. (2013). Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I). Allergy, 68(4), pp. 425-39. doi:10.1111/all.12106.
    Moreira A, et al. Weight Loss Interventions in Asthma: EAACI Evidence-based Clinical Practice Guideline (part I). Allergy. 2013;68(4):425-39. PubMed PMID: 23452010.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I). AU - Moreira,A, AU - Bonini,M, AU - Garcia-Larsen,V, AU - Bonini,S, AU - Del Giacco,S R, AU - Agache,I, AU - Fonseca,J, AU - Papadopoulos,N G, AU - Carlsen,K H, AU - Delgado,L, AU - Haahtela,T, Y1 - 2013/03/01/ PY - 2012/12/05/accepted PY - 2013/3/5/entrez PY - 2013/3/5/pubmed PY - 2013/9/7/medline SP - 425 EP - 39 JF - Allergy JO - Allergy VL - 68 IS - 4 N2 - BACKGROUND: Asthma and obesity are chronic multifactorial conditions that are associated with gene-environment interaction and immune function. Although the data are not fully consistent, it seems that obesity increases the risk of asthma and compromises asthma control. OBJECTIVE: To investigate the impact that weight changes have on asthma. METHODS: We carried out a systematic review of three large biomedical databases. Studies were scrutinized and critically appraised according to agreed exclusion and inclusion criteria. Quality assessment of eligible papers was conducted using the GRADE method. Meta-analyses of comparable studies were carried out. RESULTS: Thirty studies met the eligibility criteria of the review. Interventions were limited to dietary manipulation in three studies, one of which also used anti-obesity drugs, and bariatric surgery in four. All the other studies reported observational data. Becoming obese increased the odds for incident asthma by 1.82 (95% CI 1.47, 2.25) in adults and 1.98 (95% CI 0.71, 5.52) in children. Weight loss was associated with significant improvement in mean scores for symptoms, rescue medication score, and asthma exacerbations in the only randomized controlled trial. Similarly, evidence gathered from observational studies, with follow-up ranging between 8 weeks to 1 year, and from changes 1 year after bariatric surgery showed improvements in all asthma control-related outcomes. Changes in lung function were reported in one randomized controlled and eight observational studies of asthmatic subjects, with conflicting results. Either improvement after weight loss, decline with weight gain, or no effects at all were reported. Changes in airway inflammation and responsiveness were reported only by observational studies. CONCLUSION: Weight increases above the obesity threshold significantly increase the risk of asthma. The available studies show weak evidence of benefits from weight reduction on asthma outcomes. SN - 1398-9995 UR - https://www.unboundmedicine.com/medline/citation/23452010/full_citation L2 - https://doi.org/10.1111/all.12106 DB - PRIME DP - Unbound Medicine ER -