The Nonallergic Asthma of Obesity A Matter of Distal Lung Compliance

Rationale: The pathogenesis of asthma in obesity is poorly understood, but may be related to breathing at low lung volumes. Objectives: To determine if lung function in obese patients with asthma and control subjects would respond differently to weight loss. Methods: Lung function was evaluated by conventional clinical tests and by impulse oscillometry in female late-onset, nonallergic patients with asthma and control subjects before, and 12 months after, bariatric surgery. Measurements and Main Results: Patients with asthma (n = 10) had significantly lower FEV1 (79.8 +/- 10.6 vs. 95.5 +/- 7.0%) and FVC (82.4 +/- 13.2 vs. 93.7 +/- 8.9%) compared with control subjects (n = 13). There were no significant differences in FRC or TLC at baseline. Twelve months after surgery, control subjects had significant increases in FEV1 (95.5 +/- 7.0 to 100.7 +/- 5.9), FVC (93.6 +/- 8.9 to 98.6 +/- 8.3%), FRC (45.4 +/- 18.5 to 62.1 +/- 15.3%), and TLC (84.8 +/- 15.0 to 103.1 +/- 15.3%), whereas patients with asthma had improvement only in FEV1 (79.8 +/- 10.6 to 87.2 +/- 11.5). Control subjects and patients with asthma had a significantly different change in respiratory system resistance with weight loss: control subjects exhibited a uniform decrease in respiratory system resistance at all frequencies, whereas patients with asthma exhibited a decrease in frequency dependence of resistance. Fits of a mathematical model of lung mechanics to these impedance spectra suggest that the lung periphery was more collapsed by obesity in patients with asthma compared with control subjects. Conclusions: Weight loss decompresses the lung in both obese control subjects and patients with asthma, but the more pronounced effects of weight loss on lung elastance suggest that the distal lung is inherently more collapsible in people with asthma.