Abstract
Background:
Obesity is associated with increased prevalence and incidence of asthma, but the mechanism is unknown. Obesity reduces lung volumes, which can increase airway responsiveness, and increases resistive and elastic work of breathing, which can increase dyspnea.
Objective:
To determine if the intensity of dyspnea due to airway narrowing or if airway responsiveness is increased in obese, non-asthmatic subjects.
Subjects:
Twenty-three obese (BMI (body mass index) ⩾30 kg m−2) and 26 non-obese (BMI <30 kg m−2) non-asthmatic subjects, aged between 18 and 70 years.
Methods:
High-dose methacholine challenge was used to determine the sensitivity and the maximal response to methacholine. Respiratory system resistance (Rrs) and reactance were measured, using the forced oscillation technique, as indicators of resistive and elastic loads during challenge. Perception of dyspnea was measured by the Borg score during challenge. Static lung volumes were measured by body plethysmography.
Results:
Static lung volumes were reduced in the obese subjects. There were no significant differences in the sensitivity or maximal response to methacholine between obese and non-obese subjects. The magnitude of change in Rrs was similar in both groups, but obese subjects had more negative reactance after challenge (P=0.002) indicating a greater elastic load. The intensity of dyspnea was greater in obese subjects (P=0.03).
Conclusions:
Obesity reduces lung volumes, but does not alter the sensitivity or maximal response to methacholine. However, obese subjects have enhanced perception of dyspnea, associated with greater apparent stiffness of the respiratory system, and may therefore be at greater risk of symptoms.
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References
Shore SA, Johnston RA . Obesity and asthma. Pharmacol Ther 2006; 110: 83–102.
Beuther DA, Sutherland ER . Overweight, obesity and incident asthma: a meta-analysis of prospective epidemiological analysis. Am J Respir Crit Care Med 2007; 175: 661–666.
Bustos P, Amigo H, Oyarzun M, Rona RJ . Is there a causal relation between obesity and asthma? Evidence from Chile. Int J Obes 2005; 29: 804–809.
Huang SL, Shiao G, Chou P . Association between body mass index and allergy in teenage girls in Taiwan. Clin Exp Allergy 1999; 29: 323–329.
Schachter LM, Peat JK, Salome CM . Asthma and atopy in overweight children. Thorax 2003; 58: 1031–1035.
Schachter LM, Salome CM, Peat JK, Woolcock AJ . Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax 2001; 56: 4–8.
Hancox RJ, Milne BJ, Poulton R, Taylor DR, Greene JM, McLachlan CR et al. Sex differences in the relation between body mass index and asthma and atopy in a birth cohort. Am J Respir Crit Care Med 2005; 171: 440–445.
Sin DD, Jones RL, Man SF . Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med 2002; 162: 1477–1481.
Leung TF, Li CY, Lam CW, Au CS, Yung E, Chan IH et al. The relation between obesity and asthmatic airway inflammation. Pediatr Allergy Immunol 2004; 15: 344–350.
Woolcock AJ, Salome CM, Yan K . The shape of the dose–response curve to histamine in asthmatic and normal subjects. Am Rev Respir Dis 1984; 130: 71–75.
Sterk PJ, Daniel EE, Zamel N, Hargreave FE . Limited bronchoconstriction to methacholine using partial flow-volume curves in nonasthmatic subjects. Am Rev Respir Dis 1985; 132: 272–277.
King GG, Brown NJ, Diba C, Thorpe CW, Munoz P, Marks GB et al. The effects of body weight on airway calibre. Eur Respir J 2005; 25: 896–901.
Ding DJ, Martin JG, Macklem PT . Effects of lung volume on maximal methacholine—induced bronchoconstriction in normal humans. J Appl Physiol 1987; 62: 1324–1330.
Shardonofsky FR, Martin JG, Eidelman DH . Effect of body posture on concentration–response curves to inhaled methacholine. Am Rev Respir Dis 1992; 145: 750–755.
Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G . Effects of obesity on respiratory resistance. Chest 1993; 103: 1470–1476.
Rubinstein I, Zamel N, DuBarry L, Hoffstein V . Airflow limitation in morbidly obese, nonsmoking men. Ann Intern Med 1990; 112: 828–832.
Naimark A, Cherniack RM . Compliance of the respiratory system and its components in health and obesity. J Appl Physiol 1960; 15: 377–382.
Briscoe WA, DuBois A . The relationship between airway resistance, airway conductance, and lung volume in subjects of different age and body size. J Clin Invest 1959; 37: 1279–1285.
Crapo RO, Morris AH, Clayton PO, Nixon CR . Lung volumes in healthy non-smoking adults. Bull Eur Physiopathol Respir 1982; 18: 419–425.
Quanjer PH, Tammeling GJ, Cotes JE, Pederson OF, Peslin R, Yernault J-C . Lung volumes and forced ventilatory flows. Report of the Working Party on Standardization of Lung Function Tests, European Community for Coal and Steel. Eur Respir J 1993; 6: 5–40.
Chai H, Farr RS, Froehlich LA, Mathison DA, McLean JA, Rosenthal RR et al. Standardisation of bronchial inhalation challenge procedures. J Allergy Clin Immunol 1975; 56: 323–327.
Boonsawat W, Salome CM, Woolcock AJ . Effect of allergen inhalation on the maximal response plateau of the dose–response curve to methacholine. Am Rev Respir Dis 1992; 146: 565–569.
Simon PM, Schwartzstein RM, Weiss JW, Fencl V, Teghtsoonian M, Weinberger SE . Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis 1990; 142: 1009–1014.
Thorpe CW, Salome CM, Berend N, King GG . Modeling airway resistance dynamics after tidal and deep inspirations. J Appl Physiol 2004; 97: 1643–1653.
Chinn S, Jarvis D, Burney P . Relation of bronchial responsiveness to body mass index in the ECRHS. Thorax 2002; 57: 1028–1033.
Litonjua AA, Sparrow D, Celedon JC, DeMolles D, Weiss ST . Association of body mass index with the development of methacholine airway hyperresponsiveness in men: the Normative Aging Study. Thorax 2002; 57: 581–585.
Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87: 654–660.
Thomson CC, Clark S, Camargo Jr CA . Body mass index and asthma severity among adults presenting to the emergency department. Chest 2003; 124: 795–802.
Boulet L-P, Leblanc P, Turcotte H . Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest 1994; 105: 1430–1433.
James AL, Carroll N, De Klerk N, Elliot J, Musk AW, Ryan G . Increased perception of airway narrowing in patients with mild asthma. Respirology 1998; 3: 241–245.
Salome CM, Reddel HK, Ware SI, Roberts AM, Jenkins CR, Marks GB et al. Effect of budesonide on the perception of induced airway narrowing in subjects with asthma. Am J Respir Crit Care Med 2002; 165: 15–21.
Bijl-Hofland ID, Folgering HTM, van den Hoogen H, Cloosterman SGM, Van Weel C, Donkers JM et al. Perception of bronchoconstriction in asthma patients measured during histamine challenge test. Eur Respir J 1999; 14: 1049–1054.
Lougheed MD, Lam M, Forkert L, Webb KA, O'Donnell DE . Breathlessness during acute bronchoconstriction in asthma. Am Rev Respir Dis 1993; 148: 1452–1459.
Axen K, Haas SS, Haas F, Gaudino D, Haas A . Ventilatory adjustments during sustained mechanical loading in conscious humans. J Appl Physiol 1983; 55: 1211–1218.
Hedenstierna G, Santesson J, Norlander O . Airway closure and distribution of inspired gas in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaestheiol Scand 1976; 20: 334–342.
Ronmark E, Andersson C, Nystrom L, Forsberg B, Jarvholm B, Lundback B . Obesity increases the risk of incident asthma among adults. Eur Respir J 2005; 25: 282–288.
Celedon JC, Palmer LJ, Litonjua AA, Weiss ST, Wang B, Fang Z et al. Body mass index and asthma in adults in families of subjects with asthma in Anqing, China. Am J Respir Crit Care Med 2001; 164: 1835–1840.
Jansen DF, Timens W, Kraan J, Rijcken B, Postma DS . (A)symptomatic bronchial hyperresponsiveness and asthma. Respir Med 1997; 91: 121–134.
Acknowledgements
The study was funded by the Asthma Foundation of NSW.
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Salome, C., Munoz, P., Berend, N. et al. Effect of obesity on breathlessness and airway responsiveness to methacholine in non-asthmatic subjects. Int J Obes 32, 502–509 (2008). https://doi.org/10.1038/sj.ijo.0803752
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DOI: https://doi.org/10.1038/sj.ijo.0803752
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