Treatment of Asthma in Obese Individuals

Core Treatment Strategy

Weight reduction is recommended in obese patients with asthma to improve asthma control, and should be achieved through a comprehensive lifestyle intervention combining reduced-calorie diet, exercise/increased physical activity, and behavioral counseling 1, 2, 3, 4, 5
The intervention must include all three elements: reduced-calorie diet, exercise/increased physical activity, and behavioral counseling 1, 2, 3, 4, 5
A reduced-calorie diet, especially meal substitution programs, is a key component of the comprehensive lifestyle intervention 6
Behavioral counseling and modifications are also essential components of the intervention 6
Physical training improves cardiopulmonary efficiency and should be part of general lifestyle rehabilitation, with appropriate precautions for exercise-induced asthma 1, 2, 3, 4, 5

Inhaled corticosteroids (ICS) remain the most consistently effective long-term control medication at all steps of care for persistent asthma 7, 8
ICS improve asthma control more effectively than leukotriene receptor antagonists or any other single long-term control medication 7, 8

Evaluate for obstructive sleep apnea, particularly in overweight/obese patients with poorly controlled asthma 7, 8
Assess for gastroesophageal reflux, especially in patients with frequent nighttime symptoms or poorly controlled asthma 7, 8
GERD treatment includes avoiding heavy meals, fried foods, caffeine, and alcohol; avoiding food/drink within 3 hours of bedtime; elevating head of bed 6-8 inches; and using proton pump inhibitors 7, 8

For patients unable to achieve or sustain weight loss through comprehensive lifestyle intervention, consider adjunctive pharmacotherapy if BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities (such as asthma), unless contraindicated 6
Liraglutide has been studied in obese patients with moderate OSA and produced significant weight loss (mean difference -4.9 kg) 6