Abstract：
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.
摘要：
将肥胖视为哮喘的可治疗特征，影响它的发展，临床表现和管理，正在获得广泛接受。肥胖是哮喘的重要危险因素和疾病调节因子，复杂的治疗。流行病学证据表明，肥胖哮喘与较差的疾病控制相关，增加的严重性和持久性，肺功能受损，生活质量下降。在患有肥胖和哮喘的个体中观察到的各种机制有助于生理和临床复杂性。这些包括不同的免疫反应，包括IVb型，其中T辅助细胞2是关键的，由细胞因子如白细胞介素4、5、9和13和IVc型驱动，以辅助性T细胞17和产生白细胞介素17的3型先天淋巴细胞为特征，白细胞介素17招募嗜中性粒细胞。此外,V型涉及免疫应答失调,具有T辅助1、2和17应答的显著激活。最后,VI型被认为是与肥胖相关的代谢诱导的免疫失调。体重指数（BMI）是哮喘可治疗特征的生物标志物，易于识别和定位，对疾病管理具有重要意义。肥胖哮喘患者的治疗选择存在明显差距，哮喘管理指南缺乏特异性。例如,目前没有证据支持在无2型糖尿病(T2DM)的哮喘患者中使用肠促胰岛素模拟物改善哮喘结局.在这次审查中,我们主张通过建立明确的目标BMI目标，将BMI纳入哮喘护理模式，通过健康的饮食选择和身体活动促进可持续的体重减轻，并在必要时定期进行重新评估和转诊。
