Uncontrolled asthma is Associated with Increased Visceral Adipose Tissue, Decreased Bone Mineral Content, and Reduced Exercise Capacity.

Abstract

Introduction: Physical inactivity due to shortness of breath is common among patients with uncontrolled asthma. We evaluated the body mass composition and exercise capacity of patients with poorly controlled asthma, despite maximal inhalation therapy.

Methods:  We recruited 56 patients from the Asthma Clinic of the University Hospital of Liège between September 2020 and December 2023, and 14 healthy subjects. Patients with asthma underwent detailed investigations, including induced sputum, exercise testing, and Dual-Energy X-ray Absorptiometry (DXA), to determine overall body fat mass and fat-free mass, while healthy subjects only underwent DXA. This study was approved by the Ethics Committee (2019/362).

Results:  The mean age of patients with asthma was 45 years ± 12; 58% were female, 10% were active smokers, and mean post-BD Forced Expiratory Volume in one second was 85.7% predicted. Compared to healthy subjects, asthmatics had a higher BMI (28.5±5.1 kg/m2 vs 22.5 ±2.8 kg/m2, p<0.0001) and fat mass index (FMI; 10.3 ± 3.7 vs 5.9 ± 2.8 kg/m2, p=0.0005), lower lean and bone mass (62% vs 71%, p=0.0012), and greater android fat distribution (1.00 ± 0.22 vs 0.80 ± 0.13, p<0.0001). Eosinophilic asthma (sputum eosinophil count of ≥3%) was characterized by a better VO₂ max compared to non-eosinophilic asthma (20.7 [17.8-24.3] vs 17.3 [14.0-18.9], p=0.04). Higher lean mass was correlated with better asthma control and lower depression scores. Lean mass and bone mineral content correlated with maximal expiratory, inspiratory, and maximal aerobic power.

Conclusion:  Our study confirmed that patients with uncontrolled asthma were overweight and had decreased exercise capacity.