By: Austin Perlmutter, MD, Medical Student, Miller School of Medicine
As the top cause of pediatric hospitalizations, emergency room visits and missed school days, asthma is anything but a trivial problem for American children. Yet this issue also pushes deep into our adult population. The CDC’s data shows that 9.3% of American children and 8% of American adults live with this debilitating condition.
Research on asthma has mainly focused on how to minimize exposure to environmental irritants, and how to properly subdue the airway’s reactivity with steroids and other drugs.
This largely pharmaceutical-based research makes us better at lowering the inflammation that occurs in asthma, leading to fewer exacerbations for our patients. However, it doesn’t explain how we get asthma, or how to prevent or reverse it. Yet science has finally started to catch up. For the first time, we’re beginning to understand how important diet and lifestyle are to prevention and treatment of this condition.
Recent data shows that obese children and adults have higher rates of asthma, and that being obese may increase risk of developing asthma by up to 92%. Obesity also leads to more symptoms in people with asthma, as well need for more medication. In fact, obese asthmatics may have up to a 5-fold increase in hospitalizations compared to thinner asthmatic peers. As you might expect, losing the weight may work wonders in asthma, with a recent study finding that a loss of 5-10% of weight in obese participants significantly improved asthma control, while simultaneously improving quality of life
The connection between asthma and obesity continues to be explored, but it appears to involve the hormones of obesity and their pro-inflammatory cascade. Molecules like TNF alpha, leptin and interleukins are elevated in obesity, and set off a series of events that seem to contribute to increased airway reactivity and remodeling found in asthmatics.
So if the latest research tells us that weight loss is key for asthma, how do we accomplish this? Of course, there are barriers. Asthmatics use steroids, which lead to weight gain. Asthmatics also tend to avoid exercise, as it exacerbates their condition. These issues are important.
The first thing to clarify is that asthma should not be reason to avoid normal activities. This way of thinking has been abandoned, and children should be treated with medication to allow them to take part in exercise as they like. Without exercise, a vicious cycle of deconditioning and sedentary lifestyle is created, leading to obesity and the very problems we were seeking to avoid. Secondly, steroids are given only for more severe versions of asthma. Using the accepted medication protocols, if we could lower need for medications with mild weight loss, steroids might not be necessary. Getting over this hump would facilitate further weight loss and lessen asthmatic symptoms.
For those asthmatics who don’t struggle with their weight, as well as those who do, there are other important breakthroughs to consider. Omega 3 rich fish oil has been shown to help elite athletes with breathing, and when it was used in asthmatics, it improved lung function, lowering TNF alpha and other inflammatory markers. Another study showed that omega 3 fatty acids also lower airway reactivity in asthmatics. Finally, a diet high in whole foods rich in anti-oxidants showed improvement in asthma exacerbations and inflammatory markers.
Asthma remains one of the most common and significant medical conditions we face today, and research on how to prevent and reverse this condition has been slow to catch up. However, the recent evidence on the important of lifestyle and nutrition in prevention and treatment of asthma is extremely encouraging. Here are the take home points:
- Obesity is a pro-inflammatory condition that may play a large role in the pathogenesis of asthma.
- Lowering your weight may help prevent asthma, as well as decreasing asthmatic hospitalizations, medications, and symptoms.
- Exercise should be encouraged in asthmatics, so work with your doctor to get your asthma under control first, then be as active as you want!
- Supplementation with omega-3 fatty acids and high anti-oxidant foods lowers inflammation and improves lung function, as well as decreasing airway reactivity.