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Title: Glucocorticoids Not as Effective in Obese Patients With Asthma
URL: http://www.pslgroup.com/dg/231546.htm
Doctor's Guide
October 24, 2008

NEW YORK -- October 24, 2008 -- Glucocorticoids are 40% less effective in overweight and obese patients with asthma than in those of normal weight, according to a study in the October issue of American Journal of Respiratory and Critical Care Medicine.

The study also identified a potential mechanism involved in the resistance, which suggests therapeutic targets for future medications.

"This study identifies what could be a significant issue for the 20 million Americans with asthma," said E. Rand Sutherland, MD, National Jewish Health, Denver, Colorado.

"These findings should spur doctors to carefully evaluate response to treatment in overweight and obese asthmatics and consider optimising therapeutic regimens as indicated. We also hope they will spur additional research into the treatment of obese patients with asthma."

Dr. Sutherland and colleagues enrolled 45 nonsmoking adults, 33 of whom had asthma, and measured the response of cells in the blood and the lungs to dexamethasone.

When the researchers applied dexamethasone to cultures of the participants' blood cells, they found that the steroids did not increase MAP kinase phosphatase-1 (MKP-1) as effectively in overweight and obese asthmatics when compared to lean asthmatics.

Dexamethasone increased the levels of MKP-1 by 5.27 times in cultured blood cells from lean asthma patients, whereas MKP-1 levels in overweight and obese asthmatics increased by only 3.11 times, a 41% smaller response. The heavier a person was the less their cells were likely to respond to dexamethasone. This negative relationship between weight and response to steroids did not occur in participants who did not have asthma.

"Steroids were clearly less effective in overweight and obese asthma patients. Previous studies have suggested a link between weight and response to steroids in patients, and this study suggests a potential mechanism by which this occurs," said Dr. Sutherland

"It also suggests that future research should be directed specifically to understanding how asthma medications work in overweight and obese asthmatics. It is important to note, however, that inhaled steroids are still effective in overweight and obese asthmatics."

SOURCE: American Thoracic Society

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