肥胖与哮喘:实施可治疗特质护理模式。

IF 6.3 2区 医学 Q1 ALLERGY
Clinical and Experimental Allergy Pub Date : 2024-11-01 Epub Date: 2024-06-27 DOI:10.1111/cea.14520
Francisca Castro Mendes, Vanessa Garcia-Larsen, André Moreira
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引用次数: 0

摘要

肥胖是一种可治疗的哮喘特征,会对哮喘的发展、临床表现和管理产生影响,这一观点正在被广泛接受。肥胖是哮喘的一个重要危险因素和疾病调节因素,使治疗变得更加复杂。流行病学证据表明,肥胖型哮喘与疾病控制较差、严重程度和持续性增加、肺功能受损和生活质量下降有关。在肥胖和哮喘患者身上观察到的生理和临床复杂性是由多种机制造成的。这些机制包括不同的免疫反应,其中 IVb 型以 T 辅助 2 细胞为关键,由白细胞介素 4、5、9 和 13 等细胞因子驱动;IVc 型以 T 辅助 17 细胞和 3 型先天淋巴细胞产生白细胞介素 17 为特征,白细胞介素 17 可招募中性粒细胞。此外,V 型涉及免疫反应失调,T 辅助细胞 1、2 和 17 反应显著激活。最后,VI 型被认为是与肥胖有关的新陈代谢引起的免疫失调。体重指数(BMI)是哮喘病可治疗性状的生物标志物,易于识别且具有针对性,对疾病管理具有重要意义。肥胖哮喘患者的治疗方案存在明显差距,哮喘管理指南缺乏针对性。例如,目前没有证据支持使用增量胰岛素模拟物来改善无 2 型糖尿病(T2DM)的哮喘患者的哮喘治疗效果。在本综述中,我们主张将体重指数纳入哮喘护理模式,方法是制定明确的体重指数目标,通过健康饮食选择和体育锻炼促进可持续的体重减轻,并在必要时进行定期重新评估和转诊。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Obesity and Asthma: Implementing a Treatable Trait Care Model.

Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.

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来源期刊
CiteScore
10.40
自引率
9.80%
发文量
189
审稿时长
3-8 weeks
期刊介绍: Clinical & Experimental Allergy strikes an excellent balance between clinical and scientific articles and carries regular reviews and editorials written by leading authorities in their field. In response to the increasing number of quality submissions, since 1996 the journals size has increased by over 30%. Clinical & Experimental Allergy is essential reading for allergy practitioners and research scientists with an interest in allergic diseases and mechanisms. Truly international in appeal, Clinical & Experimental Allergy publishes clinical and experimental observations in disease in all fields of medicine in which allergic hypersensitivity plays a part.
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