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Predictors of response to rescue inhalers in adult asthma and associations with fatty acid biomarkers and weight loss

Published online by Cambridge University Press:  22 March 2023

B.S. Berthon
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia Immune Health Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
C.A. Thompson
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia Immune Health Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
H.A. Scott
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia Immune Health Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
P.G. Gibson
Affiliation:
Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
L.G. Wood
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia Immune Health Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Abstract

Type
Abstract
Copyright
Copyright © The Authors 2023

Bronchodilator response (BDR) is variable in asthma and predictors of response are unclear.(Reference Ye, Liao and D'Urzo1) A high fat meal attenuates BDR, with greater effects seen in obese subjects.(Reference Wood, Garg and Gibson2) Further, obesity adversely impacts asthma medication use and response, lung function, and asthma symptoms, while weight loss improves these outcomes.(Reference Peters, Dixon and Forno3) This study examines predictors of BDR in adults with asthma, including fatty acid biomarkers; and whether weight loss improves BDR. Cross-sectional analysis in adults with (n = 111, BDR+ve) and without (n = 109, BDR-ve) BDR (≥ 12% or ≥ 200 ml Δ forced expiratory volume in 1 second (FEV1)) to salbutamol following bronchial provocation challenge and longitudinal analysis of obese subjects who achieved weight loss through bariatric surgery (n = 8) or dietary modification (n = 16). Assessment included spirometry, hypertonic saline (4.5%) challenge with sputum induction, fraction of exhaled nitric oxide (FeNO) and asthma control. Fatty acids were measured in plasma and erythrocyte membranes (RBC) by gas chromatography. Analysis was performed with Spearman's Rank-Order correlations and Multivariate linear regression. Subjects with significant BDR had lower lung function (FEV1 % predicted, p = 0.001), increased airway hyperreactivity (p < 0.001) and increased T2 airway inflammation (FeNO, p = 0.001 and % sputum eosinophils, p < 0.001) v. subjects who did not respond to salbutamol post challenge. There were no differences in plasma fatty acids, though higher RBC C18:0% (p = 0.042), lower C18:3n-3 (p = 0.045) and total monounsaturated fatty acids (MUFA) % (p = 0.048) were seen in BDR-ve subjects, while BDR was negatively associated with RBC C20:1n-9% (Rs = −0.31, p = 0.003). Predictors of BDR included female sex (p = 0.005), higher airway inflammation (FeNO, p = 0.006) and higher airway reactivity (p < 0.001). Following weight loss (ΔBMI: −10.9% kg/m2, 95% CI [−28.9, −7.3], p < 0.001), rescue inhaler use decreased (p = 0.008) and asthma control improved (p < 0.001), with no difference in BDR. Plasma total saturated fatty acids (SFA)% (p = 0.043) and total plasma omega-6 polyunsaturated fatty acids (PUFA) (p = 0.041) decreased, while total plasma (p = 0.002) and RBC omega-3 PUFA % increased. Lower rescue inhaler use was associated with decreased RBC C18:0% (Rs = 0.79, p = 0.008) and C20:1n-9% (Rs = 0.81, p = 0.005). Fatty acid biomarkers did not predict BDR, and weight loss did not improve BDR. However, in erythrocyte membranes, subjects with significant BDR had lower SFA and higher n-3 PUFA, while lower SFA and MUFA concentrations were associated with reduced rescue inhaler use following weight loss. Future studies investigating whether BDR can be improved by weight loss or improving diet quality, with a focus on modifying dietary fat intake are needed.

References

Ye, Q, Liao, A & D'Urzo, A (2018) Expert Rev Respir Med 12, 265267.CrossRefGoogle Scholar
Wood, LG, Garg, ML & Gibson, PG (2011) J Allergy Clin Immunol 127, 11331140.CrossRefGoogle Scholar
Peters, U, Dixon, AE & Forno, E (2018) J Allergy Clin Immunol 141, 11691179.CrossRefGoogle Scholar