ẢNH HƯỞNG CỦA BÉO PHÌ LÊN HEN PHẾ QUẢN: TỪ SINH LÝ BỆNH ĐẾN ĐIỀU TRỊ
Nội dung chính của bài viết
Tóm tắt
Tỷ lệ béo phì và hen phế quản đều đang ngày càng gia tăng. Béo phì góp phần vào tăng tỷ lệ mắc và tăng độ nặng của hen. Cơ chế ảnh hưởng của béo phì lên hen vẫn chưa rõ ràng. Tuy nhiên hiện nay có 2 thuyết chính để giải thích cho cơ chế này là thông qua viêm và không do viêm. Tình trạng tăng phản ứng đường thở ở người béo phì như một hậu quả của việc giảm thể tích chức năng của phổi. Mô mỡ được xem là một cơ quan nội tiết, tiết ra một số cytokine tiền viêm, chemokine, yếu tố tăng trưởng và adipokine như leptin, adiponectin và resistin. Leptin và resistin gây viêm, trong khi adiponectin chủ yếu có đặc tính chống viêm. Leptin tăng ở bệnh nhân béo phì, là yếu tố giải thích mối liên quan giữa béo phì và hen phế quản. Chế độ ăn uống có nhiều chất béo no và ít chất xơ có liên quan đến cả việc tăng nguy cơ béo phì và kiểm soát triệu chứng hen phế quản kém ở những bệnh nhân béo phì và không béo phì. Giảm hoạt động thể chất cũng liên quan đến béo phì và kết cục bệnh hen phế quản trở nên xấu hơn với chức năng phổi giảm nhanh hơn. Giảm cân bằng chế độ ăn và tập luyện kiểm soát hen tốt hơn những bệnh nhân chỉ giảm cân đơn thuần bằng chế độ ăn hoặc phẫu thuật. Điều trị béo phì có nghĩa cân bằng năng lượng âm: năng lượng đưa vào thấp hơn năng lượng tiêu hao. Do đó để cải thiện chất lượng cuộc sống ở bệnh nhân hen béo phì không thể đơn thuần chỉ là điều chỉnh cân nặng thông qua giảm năng lượng đưa vào mà cần kết hợp cả hoạt động thể chất.
Từ khóa
hen, béo phì, thừa cân
Chi tiết bài viết
Tài liệu tham khảo
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14. Luiz, O., A. Milton, and J. Mario, Obesity And Asthma: Beyond T (h) 2 Inflammation. doi: 10.1016/j.metabol.2014.10.002
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16. Freitas, P.D., et al., The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial. American journal of respiratory and critical care medicine. 2017. 195(1), 32-42. doi: 10.1164/rccm.201603-0446OC.
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25. Trompette, A., et al., Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nature medicine. 2014. 20(2), 159-166. DOI: 10.1038/nm.3444
26. Wood, L.G., M.L. Garg, and P.G. Gibson, A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma. Journal of Allergy and Clinical Immunology,
2011. 127(5), 1133-1140. DOI: 10.1016/j.jaci.2011.01.036
27. Oudjedi, A. and K.S. Aissa, Associations between obesity, asthma and physical activity in children and adolescents. Apunts Sports Medicine. 2020. 55(205), 39-48. doi.org/10.1016/j.apunsm.2020.02.003
28. França-Pinto, A., et al., Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial. Thorax,
2015. 70(8), 732-739. DOI: 10.1136/thoraxjnl-2014-206070
29. Hewitt, M., et al., Acute exercise decreases airway inflammation, but not responsiveness, in an allergic asthma model. American Journal of Respiratory Cell and Molecular Biology. 2009. 40(1), 83-89. doi: 10.1165/rcmb.2008-0172OC
30. Handzlik, M.K., et al., The influence of exercise training status on antigen-stimulated IL-10 production in whole blood culture and numbers of circulating regulatory T cells. European journal of applied physiology. 2013. 113, 1839-1848. DOI: 10.1007/s00421-013-2614-y
31. Fernandes, P., et al., Physical exercise induces immunoregulation of TREG, M2, and pDCs in a lung allergic inflammation model. Frontiers in immunology. 2019. 10, 854. doi: 10.3389/fimmu.2019.00854
32. Freitas, P.D., et al., Exercise improves physical activity and comorbidities in obese adults with asthma, 2018, Eur Respiratory Soc. DOI: 10.1249/MSS.0000000000001574
33. Kuder, M.M. and S.M. Nyenhuis, Optimizing lifestyle interventions in adult patients with comorbid asthma and obesity. Therapeutic Advances in Respiratory Disease. 2020. 14, 1753466620906323. doi: 10.1177/1753466620906323
34. Kanwar, M.K., et al., Beneficial Effects of Glucagon-Like Peptide-1 Receptor Agonists in
Patients With Asthma: A Literature Review. Cureus. 2022. 14(10).
DOI: 10.1177/1753466620906323
35. Tashiro, H., et al., Impact of obesity in asthma: Possible future therapies. Allergology International. 2024. 73(1), 8-57. doi.org/10.1016/j.alit.2023.08.007
10.3390/jcm12051843
2. Alqarni, A.A., et al., Prevalence of overweight and obesity and their impact on spirometry parameters in patients with asthma: a multicentre, retrospective study. Journal of clinical medicine. 2023. 12(5), 1843, doi: 10.3390/jcm12051843.
3. McLachlan, C.R., et al., Adiposity, asthma, and airway inflammation. Journal of Allergy and Clinical Immunology. 2007. 119(3), 634-639. DOI: 10.1016/j.jaci.2006.10.029
4. Todd, D., et al., Effect of obesity on airway inflammation: a cross sectional analysis of body mass index and sputum cell counts. Clinical & Experimental Allergy. 2007. 37(7), 10491054. doi: 10.1111/j.1365-2222.2007.02748.x.
5. Dixon, A.E. and U. Peters, The effect of obesity on lung function. Expert review of respiratory medicine. 2018. 12(9), 755-767. doi: 10.1080/17476348.2018.1506331
6. Behazin, N., et al., Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. Journal of applied physiology. 2010. 108(1), 212-218. doi: 10.1152/japplphysiol.91356.2008.
7. Jones, R.L. and M.-M.U. Nzekwu, The effects of body mass index on lung volumes. Chest, 2006. 130(3), 827-833. doi: 10.1378/chest.130.3.827.
8. Tantisira, K. and S. Weiss, Complex interactions in complex traits: obesity and asthma. Thorax, 2001. 56(suppl 2), ii64-ii74.
9. Farzan, S., et al., Clinical characteristics and management strategies for adult obese asthma patients. Journal of asthma and allergy. 2022. 15, 673-689. DOI: 10.2147/JAA.S285738
10. Shore, S.A. and J.J. Fredberg, Obesity, smooth muscle, and airway hyperresponsiveness. Journal of Allergy and Clinical Immunology. 2005. 115(5), 925-927. DOI: 10.1016/j.jaci.2005.01.064
11. Gruchała-Niedoszytko, M., et al., The influence of obesity on inflammation and clinical symptoms in asthma. Advances in medical sciences. 2013. 58(1), 15-21. DOI: 10.2478/v10039-012-0082-y.
12. Silswal, N., et al., Human resistin stimulates the pro-inflammatory cytokines TNF-α and IL-12 in macrophages by NF-κB-dependent pathway. Biochemical and biophysical research communications. 2005. 334(4), 1092-1101. DOI: 10.1016/j.bbrc.2005.06.202.
13. Sood, A., et al., Low serum adiponectin predicts future risk for asthma in women. American journal of respiratory and critical care medicine. 2012. 186(1), 41-47. doi: 10.1164/rccm.201110-1767OC.
14. Luiz, O., A. Milton, and J. Mario, Obesity And Asthma: Beyond T (h) 2 Inflammation. doi: 10.1016/j.metabol.2014.10.002
15. Thompson, C.A., et al., Asthma medication use in obese and healthy weight asthma: systematic review/meta-analysis. European Respiratory Journal. 2021. 57(3). doi: 10.1183/13993003.00612-2020.
16. Freitas, P.D., et al., The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial. American journal of respiratory and critical care medicine. 2017. 195(1), 32-42. doi: 10.1164/rccm.201603-0446OC.
17. Scott, H., et al., Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clinical & Experimental Allergy. 2013. 43(1), 36-49. DOI: 10.1111/cea.12004
18. Chaaban, T.A., Bariatric surgery: a potential cure for asthma? European Respiratory Review, 2019. 28(152). DOI: 10.1183/16000617.0003-2019
19. Nguyen, N.T., et al., Improvement of restrictive and obstructive pulmonary mechanics following laparoscopic bariatric surgery. Surgical endoscopy. 2009. 23, 808-812. DOI: 10.1007/s00464-008-0084-9
20. Mawlichanów, M., et al., Bariatric Surgery in Asthma: A Narrative Review. Medicina. 2024. 60(5), 806. doi.org/10.3390/medicina60050806
21. Sharma, V. and D.C. Cowan, Obesity, inflammation, and severe asthma: an update. Current allergy and asthma reports. 2021. 21(12), 46. DOI: 10.1007/s11882-021-01024-9
22. Freire, R., Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets. Nutrition. 2020. 69, 110549. DOI: 10.1016/j.nut.2019.07.001
23. Jessri, M., et al., Identification of dietary patterns associated with obesity in a nationally representative survey of Canadian adults: application of a priori, hybrid, and simplified dietary pattern techniques. The American journal of clinical nutrition. 2017. 105(3), 669-684. DOI: 10.3945/ajcn.116.134684
24. Hosseini, B., et al., Effects of fruit and vegetable consumption on risk of asthma, wheezing and immune responses: a systematic review and meta-analysis. Nutrients. 2017. 9(4), 341. DOI: 10.3390/nu9040341
25. Trompette, A., et al., Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nature medicine. 2014. 20(2), 159-166. DOI: 10.1038/nm.3444
26. Wood, L.G., M.L. Garg, and P.G. Gibson, A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma. Journal of Allergy and Clinical Immunology,
2011. 127(5), 1133-1140. DOI: 10.1016/j.jaci.2011.01.036
27. Oudjedi, A. and K.S. Aissa, Associations between obesity, asthma and physical activity in children and adolescents. Apunts Sports Medicine. 2020. 55(205), 39-48. doi.org/10.1016/j.apunsm.2020.02.003
28. França-Pinto, A., et al., Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial. Thorax,
2015. 70(8), 732-739. DOI: 10.1136/thoraxjnl-2014-206070
29. Hewitt, M., et al., Acute exercise decreases airway inflammation, but not responsiveness, in an allergic asthma model. American Journal of Respiratory Cell and Molecular Biology. 2009. 40(1), 83-89. doi: 10.1165/rcmb.2008-0172OC
30. Handzlik, M.K., et al., The influence of exercise training status on antigen-stimulated IL-10 production in whole blood culture and numbers of circulating regulatory T cells. European journal of applied physiology. 2013. 113, 1839-1848. DOI: 10.1007/s00421-013-2614-y
31. Fernandes, P., et al., Physical exercise induces immunoregulation of TREG, M2, and pDCs in a lung allergic inflammation model. Frontiers in immunology. 2019. 10, 854. doi: 10.3389/fimmu.2019.00854
32. Freitas, P.D., et al., Exercise improves physical activity and comorbidities in obese adults with asthma, 2018, Eur Respiratory Soc. DOI: 10.1249/MSS.0000000000001574
33. Kuder, M.M. and S.M. Nyenhuis, Optimizing lifestyle interventions in adult patients with comorbid asthma and obesity. Therapeutic Advances in Respiratory Disease. 2020. 14, 1753466620906323. doi: 10.1177/1753466620906323
34. Kanwar, M.K., et al., Beneficial Effects of Glucagon-Like Peptide-1 Receptor Agonists in
Patients With Asthma: A Literature Review. Cureus. 2022. 14(10).
DOI: 10.1177/1753466620906323
35. Tashiro, H., et al., Impact of obesity in asthma: Possible future therapies. Allergology International. 2024. 73(1), 8-57. doi.org/10.1016/j.alit.2023.08.007