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Fatty airways: implications for obstructive disease

John G. Elliot, Graham M. Donovan, Kimberley C.W. Wang, Francis H.Y. Green, Alan L. James, Peter B. Noble
European Respiratory Journal 2019 54: 1900857; DOI: 10.1183/13993003.00857-2019
John G. Elliot
1West Australian Sleep Disorders Research Institute, Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
2School of Human Sciences, The University of Western Australia, Crawley, Australia
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  • For correspondence: john.elliot@health.wa.gov.au
Graham M. Donovan
3Dept of Mathematics, University of Auckland, Auckland, New Zealand
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  • ORCID record for Graham M. Donovan
Kimberley C.W. Wang
2School of Human Sciences, The University of Western Australia, Crawley, Australia
4Telethon Kids Institute, University of Western Australia, Nedlands, Australia
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Francis H.Y. Green
5Dept of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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Alan L. James
1West Australian Sleep Disorders Research Institute, Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
6School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Australia
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Peter B. Noble
2School of Human Sciences, The University of Western Australia, Crawley, Australia
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Abstract

Epidemiological studies report that overweight or obese asthmatic subjects have more severe disease than those of a healthy weight. We postulated that accumulation of adipose tissue within the airway wall may occur in overweight patients and contribute to airway pathology. Our aim was to determine the relationship between adipose tissue within the airway wall and body mass index (BMI) in individuals with and without asthma.

Transverse airway sections were sampled in a stratified manner from post mortem lungs of control subjects (n=15) and cases of nonfatal (n=21) and fatal (n=16) asthma. The relationship between airway adipose tissue, remodelling and inflammation was assessed. The areas of the airway wall and adipose tissue were estimated by point count and expressed as area per mm of basement membrane perimeter (Pbm). The number of eosinophils and neutrophils were expressed as area densities.

BMI ranged from 15 to 45 kg·m−2 and was greater in nonfatal asthma cases (p<0.05). Adipose tissue was identified in the outer wall of large airways (Pbm >6 mm), but was rarely seen in small airways (Pbm <6 mm). Adipose tissue area correlated positively with eosinophils and neutrophils in fatal asthma (Pbm >12 mm, p<0.01), and with neutrophils in control subjects (Pbm >6 mm, p=0.04).

These data show that adipose tissue is present within the airway wall and is related to BMI, wall thickness and the number of inflammatory cells. Therefore, the accumulation of airway adipose tissue in overweight individuals may contribute to airway pathophysiology.

Abstract

In individuals with elevated BMI, adipose tissue accumulates within the airway wall, correlates with greater wall thickness and airway inflammation and represents a new mechanism for airway pathophysiology in obese asthmatic patients http://bit.ly/2maDoSp

Footnotes

  • Conflict of interest: J.G. Elliot has nothing to disclose.

  • Conflict of interest: G.M. Donovan has nothing to disclose.

  • Conflict of interest: K.C.W. Wang has nothing to disclose.

  • Conflict of interest: F.H.Y. Green has nothing to disclose.

  • Conflict of interest: A.L. James has nothing to disclose.

  • Conflict of interest: P.B. Noble has nothing to disclose.

  • Support statement: This work was supported by Health Canada, Sir Charles Gairdner and Osborne Park Health Care Group Research Advisory Committee (grant: 2017-18/001), National Health and Medical Research Council of Australia (grant: Early Career Research Fellowship 1090888), Western Australian Department of Health – Merit Award and a Medical and Health Research Infrastructure Fund.

  • Received April 30, 2019.
  • Accepted September 5, 2019.
  • Copyright ©ERS 2019
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Fatty airways: implications for obstructive disease
John G. Elliot, Graham M. Donovan, Kimberley C.W. Wang, Francis H.Y. Green, Alan L. James, Peter B. Noble
European Respiratory Journal Dec 2019, 54 (6) 1900857; DOI: 10.1183/13993003.00857-2019

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Fatty airways: implications for obstructive disease
John G. Elliot, Graham M. Donovan, Kimberley C.W. Wang, Francis H.Y. Green, Alan L. James, Peter B. Noble
European Respiratory Journal Dec 2019, 54 (6) 1900857; DOI: 10.1183/13993003.00857-2019
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