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Predictors of a Good Response to ICS Therapy in Obesity-Associated Asthma
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A1895 - Predictors of a Good Response to ICS Therapy in Obesity-Associated Asthma
Author Block: F. Schleich1, S. Peerboom1, S. Graff1, L. Seidel1, V. Paulus1, M. Henket2, C. Moermans3, R. Louis4; 1Respiratory Medicine, CHU Sart - Tilman, Liège, Belgium, 2Respiratory Medicine, CHU Sart-Tilman Liege, Liege, Belgium, 3pneumology, CHU-ULG, Liege (Sart Tilman), Belgium, 4Univ of Liege, Liege, Belgium.
Introduction Asthma in obese subjects is poorly understood. According to GINA guidelines, clinicians increase ICS in case of poor asthma control but restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation.
Methods We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease of ACQ≥0.5) versus poor response (rise of ACQ≥0.5) to ICS step-up therapy.
Results Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited restriction, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control and 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FENO levels. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts. Conclusion We observed lower asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.
Author Block: F. Schleich1, S. Peerboom1, S. Graff1, L. Seidel1, V. Paulus1, M. Henket2, C. Moermans3, R. Louis4; 1Respiratory Medicine, CHU Sart - Tilman, Liège, Belgium, 2Respiratory Medicine, CHU Sart-Tilman Liege, Liege, Belgium, 3pneumology, CHU-ULG, Liege (Sart Tilman), Belgium, 4Univ of Liege, Liege, Belgium.
Introduction Asthma in obese subjects is poorly understood. According to GINA guidelines, clinicians increase ICS in case of poor asthma control but restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation.
Methods We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease of ACQ≥0.5) versus poor response (rise of ACQ≥0.5) to ICS step-up therapy.
Results Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited restriction, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control and 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FENO levels. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts. Conclusion We observed lower asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.
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