Asthma and metabolic syndrome: Current knowledge and future perspectives

Abstract

Asthma and obesity are epidemiologically linked; however, similar relationships are also observed with other markers of the metabolic syndrome, such as insulin resistance and dyslipidemia, which cannot be accounted for by increased body mass alone. Obesity appears to be a predisposing factor for the asthma onset, both in adults and in children. In addition, obesity could make asthma more difficult to control and to treat. Although obesity may predispose to increased Th2 inflammation or tendency to atopy, other mechanisms need to be considered, such as those mediated by hyperglycaemia, hyperinsulinemia and dyslipidemia in the context of metabolic syndrome. The mechanisms underlying the association between asthma and metabolic syndrome are yet to be determined. In the past, these two conditions were believed to occur in the same individual without any pathogenetic link. However, the improvement in asthma symptoms following weight reduction indicates a causal relationship. The interplay between these two diseases is probably due to a bidirectional interaction. The purpose of this review is to describe the current knowledge about the possible link between metabolic syndrome and asthma, and explore potential application for future studies and strategic approaches.

Keywords: Asthma, Metabolic syndrome, Obesity, Hyperinsulinemia, Dyslipidemia

Core tip: Asthma is a complex syndrome that encompasses multiple phenotypes. The relationship with obesity has been addressed in the past; however, the underlying mechanism of such a relationship seems to be more complex, and not explained by the body weight alone. The metabolic syndrome carries a condition of systemic inflammation that could potentially explain the influence on asthma onset and severity. This is a rather unexplored area that could potentially open new scenario in the diagnostic algorithm and in the strategic approach, with a more comprehensive assessment of the disease.