Original Article

Obesity in asthma: more neutrophilic inflammation as a possible explanation for a reduced treatment response

  1. E. D. Telenga1,3,†,
  2. S. W. Tideman1,3,†,
  3. H. A. M. Kerstjens1,3,
  4. N. H. T. ten Hacken1,3,
  5. W. Timens2,3,
  6. D. S. Postma1,3,
  7. M. van den Berge1,3,*

Article first published online: 12 JUN 2012

DOI: 10.1111/j.1398-9995.2012.02855.x

Issue

Allergy

Allergy

Volume 67, Issue 8, pages 1060–1068, August 2012

Additional Information

How to Cite

Telenga ED, Tideman SW, Kerstjens HAM, ten Hacken NHT, Timens W, Postma DS, van den Berge M. Obesity in asthma: more neutrophilic inflammation as a possible explanation for a reduced treatment response. Allergy 2012; DOI:10.1111/j.1398-9995.2012.02855.x.

Author Information

  1. 1

    Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

  2. 2

    Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

  3. 3

    Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

  1. †

    Both authors contributed equally.

* Correspondence
Dr. Maarten van den Berge, University Medical Center Groningen (AA11), P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
Tel.: +31-50-361912357
Fax: +31-50-3619320
E-mail: m.van.den.berge@umcg.nl

  1. †

    Both authors contributed equally.

  2. Edited by: Hans-Uwe Simon

Publication History

  1. Issue published online: 12 JUL 2012
  2. Article first published online: 12 JUN 2012
  3. Manuscript Accepted: 5 MAY 2012

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Keywords:

  • asthma;
  • bronchial hyper-responsiveness;
  • corticosteroids;
  • lung function;
  • obesity

Abstract

Background

The incidence of asthma and obesity is increasing worldwide, and reports suggest that obese patients have more severe asthma. We investigated whether obese asthma patients have more severe airway obstruction and airway hyper-responsiveness and a different type of airway inflammation than lean asthmatics. Furthermore, we assessed the effect of obesity on corticosteroid treatment response.

Methods

Patient data from four well-documented asthma cohorts were pooled (n = 423). We evaluated FEV1, bronchial hyper-responsiveness (PC20) to either methacholine/histamine or adenosine 5′-monophosphate (AMP) (differential) cell counts in induced sputum and blood and corticosteroid treatment response in 118 patients.

Results

At baseline, FEV1, PC20 methacholine or histamine, and PC20 AMP values were comparable in 63 obese (BMI ≥30 kg/m2) and 213 lean patients (BMI <25 kg/m2). Obese patients had significantly higher blood neutrophils. These higher blood neutrophils were only seen in obese women and not in obese men. After a two-week treatment with corticosteroids, we observed less corticosteroid-induced improvement in FEV1%predicted in obese patients than in lean patients (median 1.7% vs 6.3% respectively, P = 0.04). The percentage of sputum eosinophils improved significantly less with higher BMI (P = 0.03), and the number of blood neutrophils increased less in obese than in lean patients (0.32 x103/μl vs 0.57 x103/μl, P = 0.046).

Conclusions

We found no differences in asthma severity between obese and nonobese asthmatics. Interestingly, obese patients demonstrated more neutrophils in sputum and blood than nonobese patients. The smaller improvement in FEV1 and sputum eosinophils suggests a worse corticosteroid treatment response in obese asthmatics.

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