Metabolic Dysfunction and Asthma: Current Perspectives

The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions have been shown to be independently rela...

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Bibliographic Details
Published in:	Journal of asthma and allergy 2020-01, Vol.13, p.237-247
Main Authors:	Pite, Helena, Aguiar, Laura, Morello, Judit, Monteiro, Emilia C, Alves, Ana Catarina, Bourbon, Mafalda, Morais-Almeida, Mario
Format:	Article
Language:	eng
Subjects:	Asthma Beta blockers Body mass index Brodalumab Cholesterol Comorbidity Corticosteroids Development and progression Diabetes diet Drug dosages Dyslipidemia Environmental factors Epidemiology Exercise Genotype & phenotype Glucose Hyperinsulinemia Hypertension Inflammation Insulin resistance Life span Lung diseases Mediation Medical research Medicine, Experimental metabolic Metabolic disorders Metabolic pathways Metabolic syndrome Metabolomics Microbiota Obesity Oxidative stress Pathogenesis Pathophysiology Patients Phenotypes Physiological aspects Precision medicine Review Risk factors Type 2 diabetes
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Summary:	The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions have been shown to be independently related to asthma. Novel insights have also recently been brought by metabolomics in this filed. The purpose of this review is to discuss current perspectives regarding metabolic dysfunction in asthma, from obesity-related asthma to other metabolic conditions and the role of current pharmacological therapeutic strategies and lifestyle interventions. Obesity is a well-recognized risk factor for asthma across the lifespan, which is generally associated with poorer response to current available treatments, rendering a more severe, refractory disease status. Besides the epidemiological and clinical link, untargeted metabolomics studies have recently supported the obesity-associated asthma phenotype at the molecular level. Not only obesity-related, but also other aspects of metabolic dysregulation can be independently linked to asthma. These include hyperinsulinemia, dyslipidemia and hypertension, which need to be taken into account, even in the non-obese patient. Untargeted metabolomics studies have further highlighted several other metabolic pathways that can be altered in asthma, namely regarding oxidative stress and systemic inflammation, and also suggesting the importance of microbiota in asthma pathogenesis. Considering the reduced response to corticosteroids, other pharmacologic treatments have been shown to be effective regardless of body mass index. Non-pharmacologic treatments (namely weight reduction and dietary changes) may bring substantial benefit to the asthmatic patient. Taken together, this evidence points towards the need to improve our knowledge in this filed and, in particular, to address the influence of environmental factors in metabolic dysfunction and asthma development. Personalized medicine is definitely needed to optimize treatment, including a holistic view of the asthmatic patient in order to set accurate pharmacologic therapy together with dietary, physical exercise and lifestyle interventions. Keywords: asthma, diet, inflammation, metabolic, metabolomics, obesity
ISSN:	1178-6965 1178-6965