The effects of obesity and fatty acids on medication use and bronchodilator response in asthma

The surge in global obesity prevalence, tripling since 1975 [1], poses a far-reaching public health challenge. In 2016, more than 650 million adults were obese (13% of the world’s population) [1]. Over a similar timeframe corresponding to the surge in obesity, we have seen a parallel rise in global asthma prevalence, affecting approximately 339 million people worldwide [2]. The concurrent rise in both conditions, especially in high-income countries [3], has sparked widespread interest in the obesity–asthma hypothesis. The negative consequences of obesity on clinical manifestations of asthma are far-reaching and detrimental [4, 5], including implications on asthma medication responsiveness [6, 7], presenting a significant complication in the treatment and management of disease in obese asthma patients. Indeed, obese asthma carries an even larger health and economic burden than asthma in healthy weight subjects [7]. Asthma medication guidelines do not differ for healthy weight and obese patients [8], though obese patients with asthma may not respond as well to standard medications [8]. The potential reduced efficacy of asthma medications in obesity is a major clinical problem considering its paramount role in controlling disease, reducing severity, treating life-threatening exacerbations, and preventing exercise induced bronchoconstriction.