Why Does Obesity Worsen Asthma?

Globally, obesity affected 650 million adults in 2016, while asthma impacted 262 million people.

In 2010, a remarkable link between obesity and asthma emerged. Among adults grappling with

current asthma, the obesity rate was notably higher than among those without asthma. This correlation between obesity and asthma is particularly pronounced in women, where obese women are more prone to asthma than their leaner counterparts.

In this article, you will learn more about the link between obesity and asthma and why obesity can worsen asthma. You will also learn some tips on managing both conditions together.

Understanding Asthma and Obesity

Asthma and obesity are separate health conditions that can impact each other due to common mechanisms and interactions. Let's find out the specifics of these two conditions:

Asthma

Asthma is a chronic respiratory disorder that affects the airways leading to the lungs. It's characterized by inflammation, narrowing of the airways, and increased sensitivity to various triggers.

Asthma can be triggered by a variety of factors, including:

• Allergens
• Pollutants
• Respiratory infections.

These triggers can lead to various symptoms, such as wheezing, shortness of breath, coughing, and chest tightness.

Asthma symptoms can range from mild to severe and can vary over time. While there's no cure for asthma, it can be managed effectively with proper treatment and lifestyle adjustments.

Obesity

Obesity, on the other hand, refers to a condition of excess body weight, typically due to excessive fat accumulation. It's often determined using the Body Mass Index (BMI), which considers a person's weight to their height. Obesity is associated with various health issues, including:

• Cardiovascular disease
• Diabetes
• Joint problems
• Respiratory complications

Factors that contribute to obesity include:

• Genetic predisposition
• Environmental factors
• Behavioral factors

Correlation Between Obesity and Asthma According to Statistics

Research findings from the Harvard School of Public Health highlight a strong association between obesity and the development and severity of asthma. The research showed:

• People with obesity have an alarming 92% higher risk of asthma development than those with lower body weight, especially among women. As BMI rises, the likelihood of asthma increases significantly. Astoundingly, one third (33%) of people with a BMI over 60 have asthma, underscoring the substantial correlation of elevated BMI with asthma.
• The connection between obesity and asthma's severity extends to severe asthma. Among adults with severe asthma, a striking 50% have obesity, a notably higher rate than the general population's obesity prevalence of 35%.
• Children with severe asthma also exhibit a higher obesity rate—30% compared to the general childhood obesity prevalence of 20%. These figures unequivocally highlight the intricate association between severe asthma and obesity.

Other research also demonstrates the relationship between asthma and obesity. The data highlight that obesity is a risk factor for the development of asthma, and it's also associated with worsened asthma symptoms and poor asthma control. In 2014, the obesity rate among adults with current asthma was notably higher (11.1%) than among adults without asthma (7.1%).

Factors Linking Obesity to the Development of Asthma

Factors linking obesity to the development of asthma are the reasons why being overweight increases the likelihood of getting asthma. These reasons show how extra body weight can make asthma more likely to happen.

Here are some factors contributing to the link between obesity and asthma:

Inflammation and Immune Responses

Obesity is associated with chronic low-grade inflammation. This inflammation can affect the airways and lead to increased airway hyperresponsiveness, worsening asthma symptoms. Adipokines, inflammatory molecules secreted by fat cells, play a key role in this process.

Adipokines like leptin and adiponectin have been shown to influence immune responses and inflammation, contributing to the intricate relationship between obesity and asthma. This shared inflammatory pathway underscores the complex interplay between these two conditions, highlighting the importance of addressing inflammation as a key factor in managing asthma in individuals with obesity.

Mechanical Factors

Excess weight can pressure the lungs and diaphragm, reducing lung function and making breathing harder. Fat accumulation in the chest and abdomen can compress the lungs, reducing their ability to expand fully. As a result, airflow in and out of the airways becomes restricted, leading to increased effort in breathing.

This reduced lung function and increased effort can contribute to a feeling of breathlessness, especially during physical activities or when asthma symptoms are triggered. Additionally, the diaphragm, a muscle responsible for aiding in breathing, may become less effective in obese individuals due to the pressure exerted by excess weight.

This combination of factors can lead to worsened asthma symptoms and decreased asthma control, further underscoring the impact of obesity on the respiratory system. Addressing these mechanical factors is essential in managing asthma in individuals with obesity and improving their overall respiratory health.

Medication Effectiveness

Obese individuals with asthma may experience reduced responses to asthma medications, particularly inhaled corticosteroids, commonly used to manage asthma symptoms and inflammation. Inhaled corticosteroids reduce inflammation in the airways, improving asthma control and preventing exacerbations.

However, due to the complex physiological changes associated with obesity, the effectiveness of these medications may be diminished in individuals with excess body weight.

Factors such as altered lung mechanics, medication distribution within the lungs, and potential changes in the body's response to medication can reduce efficacy. As a result, obese individuals with asthma might require higher doses or more frequent use of inhaled corticosteroids to achieve the same level of asthma control as individuals with a healthier weight.

The reduced effectiveness of asthma medications in obese individuals can lead to several challenges in managing asthma:

• Poorer Asthma Control: When medications are less effective, asthma symptoms may be less adequately managed. This can lead to increased frequency and severity of asthma attacks and decreased overall quality of life.
• Increased Reliance on Medications: To compensate for the reduced response to medications, obese individuals with asthma might need to use higher doses or additional medications. This can result in a greater reliance on medications to maintain asthma control, potentially leading to more side effects.
• Greater Susceptibility to Exacerbations: Since asthma control is compromised, individuals with obesity and asthma may be more susceptible to asthma exacerbations triggered by environmental factors, infections, or allergens.
• Need for Individualized Treatment: Healthcare providers must carefully tailor asthma treatment plans for obese patients, considering their specific needs and the potential challenges of reduced medication effectiveness.

Comorbidities

Obesity often coexists with other medical conditions, known as comorbidities, which can complicate asthma management and worsen its symptoms. These comorbidities can contribute to the overall disease burden for individuals with both obesity and asthma. Here are some common comorbidities associated with obesity that can impact asthma symptoms:

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a sleep disorder characterized by repetitive pauses in breathing during sleep due to a partial or complete collapse of the upper airway. It is more prevalent in individuals with obesity due to the increased fat deposits in the throat area that can obstruct airflow. OSA can lead to fragmented sleep, daytime fatigue, and reduced oxygen levels during sleep. This condition can further exacerbate asthma symptoms, as disrupted sleep and reduced oxygen intake can trigger asthma attacks and worsen overall respiratory health.

Depression

Individuals with obesity are at a higher risk of experiencing depression, a mental health disorder characterized by persistent sadness, hopelessness, and loss of interest in activities.

Depression can independently affect asthma control by influencing medication adherence, self-care practices, and overall well-being. When depression and asthma coexist, they can create a complex interplay, potentially leading to poorer asthma management and outcomes.

Cardiovascular Diseases

Obesity is a well-known risk factor for cardiovascular diseases, including hypertension (high blood pressure), coronary artery disease, and heart failure. Cardiovascular diseases can have overlapping symptoms with asthma, such as shortness of breath and chest discomfort, making distinguishing between the two conditions challenging.

Additionally, cardiovascular comorbidities can impact the choice and effectiveness of asthma medications.

Diabetes

Obesity is closely linked to type 2 diabetes, a chronic condition characterized by high blood sugar levels. Diabetes can affect lung function and increase the risk of respiratory infections, exacerbating asthma symptoms. The interplay between diabetes, obesity, and asthma can worsen health outcomes if not managed effectively.

Gastroesophageal Reflux Disease (GERD)

GERD is a condition in which stomach acid flows back into the esophagus, leading to symptoms such as heartburn and regurgitation. Obesity is a risk factor for developing GERD, and both GERD and asthma share similar symptoms, including coughing and difficulty breathing. GERD-related symptoms can trigger or worsen asthma symptoms, intertwining the management of both conditions.

Increased Inflammation from Diet

Research suggests that consuming a diet high in fat can worsen airway inflammation in people with asthma. A diet rich in high-fat foods can contribute to systemic inflammation, which can impact the respiratory system and worsen asthma symptoms.

Here's how dietary factors, specifically those related to increased inflammation, can influence the relationship between asthma and obesity:

Systemic Inflammation

Diets high in saturated and trans fats, commonly found in fried foods, processed snacks, and fatty meats, can trigger chronic low-grade inflammation throughout the body. This inflammation can affect various systems, including the respiratory system, and contribute to increased airway hyperresponsiveness, which worsens asthma symptoms.

Adipose Tissue Inflammation

Obesity is associated with inflammation due to the release of inflammatory molecules from adipose (fat) tissue, known as adipokines. A high-fat diet can further amplify adipose tissue inflammation, creating a cycle of inflammation that can exacerbate asthma symptoms.

Oxidative Stress

High-fat diets can lead to oxidative stress, a condition in which there is an imbalance between the production of reactive oxygen species (free radicals) and the body's ability to detoxify them. Oxidative stress can trigger airway inflammation and damage, worsening asthma symptoms and reducing lung function.

Immunomodulation

Dietary choices can modulate the immune response, affecting the body's ability to manage inflammation. A diet rich in unhealthy fats may promote immune responses detrimental to asthma control, while a diet rich in antioxidants and anti-inflammatory nutrients (found in fruits, vegetables, and whole grains) can have a protective effect.

Omega-6 to Omega-3 Ratio

A diet high in omega-6 fatty acids (found in vegetable oils) and low in omega-3 fatty acids (found in fatty fish and flaxseeds) can lead to an imbalance in the body's fatty acid profile. This imbalance can contribute to inflammation and impact immune responses, potentially worsening asthma symptoms.

Increased Inflammation from High-Fat Diet

A high-fat diet, commonly associated with obesity, can significantly impact asthma symptoms by promoting inflammation throughout the body, including the airways. Research suggests that consuming a diet high in saturated and trans fats can trigger chronic low-grade inflammation, which may exacerbate asthma symptoms in obese individuals.

Studies have shown that ingesting a single high-fat meal can increase neutrophilic airway inflammation and decrease bronchodilator responsiveness in people with asthma. This acute effect highlights the potential long-term consequences of a consistently high-fat diet on asthma control. The inflammatory response triggered by a high-fat diet can lead to increased oxidative stress and changes in immune cell function, both of which play crucial roles in asthma pathophysiology.

Moreover, a diet rich in unhealthy fats can alter the gut microbiome, leading to the production of inflammatory metabolites that may affect lung function. The Western diet, typically high in saturated fats and low in fiber and antioxidants, has been associated with an increased risk of asthma exacerbations and poorer asthma control.

To mitigate these effects, individuals with asthma, particularly those who are overweight or obese, should consider adopting a diet lower in saturated fats and higher in fruits, vegetables, and whole grains. This dietary approach may help reduce systemic inflammation and potentially improve asthma symptoms and overall respiratory health.

Treatment of Asthma in the Obese Patient

Treating asthma in obese patients means finding ways to help people who are overweight and have asthma. This involves using medicines, making healthy lifestyle changes, and keeping a close watch on their health to manage both their weight and their asthma symptoms.

Here are some key considerations for treating asthma in the context of obesity:

• Environmental Trigger Avoidance: Asthma management involves minimizing exposure to triggers that can induce asthma attacks. Obese patients with asthma may need additional guidance on identifying triggers related to their weight status, such as physical exertion and changes in body position.
• Co-Morbid Condition Management: Obesity often comes with other health issues like cardiovascular disease, diabetes, and sleep apnea. Treating these conditions effectively is crucial in improving asthma control.
• Pharmacotherapy: Medications play a vital role in asthma management. A stepwise approach is recommended, tailored to the patient's impairment level and risk. Obesity can impact the effectiveness of asthma medications, so healthcare providers need to adjust dosages and formulations accordingly.
• Shared Decision Making (SDM): SDM is a patient-centered approach that involves collaborating with patients to develop personalized management plans. This approach considers patients' preferences, cultural beliefs, and health literacy, promoting better adherence and outcomes.

Lifestyle Considerations for Managing Asthma and Obesity

Living with both asthma and obesity can present unique challenges, but specific lifestyle considerations can significantly improve your overall health and well-being. Here, you will learn essential lifestyle factors that significantly manage asthma and obesity effectively.

1. Diet

Making mindful choices about what you eat can profoundly impact your respiratory health and overall well-being. Here are some of the healthy foods we recommend:

• Nutrient-rich foods: Opt for a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. These foods provide essential nutrients that support your immune system and respiratory health.
• Fiber Matters: Focus on consuming foods high in soluble fiber, such as oats, legumes, and fruits like oranges and apples. Soluble fiber can help reduce inflammation and improve lung function.
• Antioxidant-Rich Foods: Include fruits and vegetables high in antioxidants like beta-carotene, and vitamins A and E. These nutrients have the potential to improve lung function and reduce asthma symptoms. Some examples include tomatoes, leafy greens, and cantaloupe.
• Limit Saturated Fats: Reduce your intake of saturated fats in fatty meats, fried foods, and full-fat dairy products. These fats can contribute to inflammation and worsen asthma symptoms.

2. Weight Management

Maintaining a healthy weight has far-reaching benefits for individuals with asthma and obesity. Here are the things to consider to achieve moderate weight loss, promote a healthier body and improve respiratory health.

• Achieve Moderate Weight Loss: Aim to lose 5-10% of your body weight if you're overweight or obese. Even this modest weight loss can significantly improve asthma control and quality of life.
• Exercise for Weight Management: Regular physical activity not only aids in weight loss but also helps control asthma symptoms. Engage in moderate-intensity exercises like walking, swimming, or cycling.

3. Healthy Lifestyle Habits

Healthy habits contribute to asthma control and address the underlying factors associated with obesity, promoting overall wellness. Here are the essential lifestyle considerations that can significantly impact asthma management for obesity:

• Stay Hydrated: Drink plenty of water to keep your airways hydrated and support overall health.
• Prioritize Physical Activity: Regular exercise helps improve lung function, strengthen your immune system, and manage weight.
• Get Enough Sleep: Adequate sleep is crucial for overall health, including managing asthma symptoms.
• Stress Management: Practice stress-reduction techniques like deep breathing, meditation, or yoga to minimize the impact of stress on your asthma.

Wrap-Up

Obesity worsens asthma due to shared mechanisms and inflammation. There is a strong link between obesity and asthma, showing higher obesity rates correlate with increased asthma risk and severity. Factors like adipokines, which promote inflammation and immune cell dysfunction, contribute to this connection.

Depression and obstructive sleep apnea complicate the interplay between obesity and asthma. Managing triggers, co-morbid conditions, and medications and adopting a healthy lifestyle are crucial for effective asthma management in the context of obesity.

FAQs on Obesity and Asthma

Is genetics a factor in the relationship between obesity and asthma?

Yes, genetics can play a role in both obesity and asthma. Specific genes may predispose individuals to both conditions, further emphasizing the complexity of their interplay.

Can weight loss alone completely alleviate asthma symptoms in obese individuals?

Weight loss can significantly improve asthma control but may not eliminate symptoms. Other factors like inflammation and immune responses are also involved in asthma development.

What role does stress play in the relationship between asthma and obesity?

Stress can exacerbate obesity and asthma symptoms due to its impact on immune responses and inflammation. Managing stress through relaxation techniques can help improve overall well-being.

Are there alternative therapies beyond medication for managing asthma in obese patients?

Yes, complementary therapies like acupuncture and breathing exercises may offer additional benefits for managing asthma symptoms, particularly when combined with conventional treatments.

Can bariatric surgery help improve asthma symptoms in obese individuals?

Bariatric surgery can lead to significant weight loss and may positively affect asthma control. However, the decision to undergo such a procedure should be carefully considered and discussed with healthcare professionals.

Do children with obesity and asthma have different treatment needs than adults?

Children with obesity and asthma may require tailored treatment plans considering their growth and developmental factors. Early intervention, lifestyle adjustments, and medication management are crucial for optimal outcomes.