Weight management program improves asthma control, life quality in patients with obesity
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Key takeaways:
- Asthma control and quality-of-life scores improved over 16 weeks in a weight management program vs. usual care.
- Patients in this program also experienced more weight loss and achieved a lower BMI.
Among adults with difficult asthma and obesity, more improvement in asthma control and quality of life was found with a weight management program vs. usual care at week 16, according to results published in CHEST.
The dietitian-led weight management program used in this study — the Counterweight-Plus Programme (CWP) — features total diet replacement with an 800 kcal/day low energy formula during weeks 0 to 12, stepwise food reintroduction during weeks 13 to 18 and weight loss maintenance during weeks 19 to 52, according to researchers. This study reports on outcomes at the 16-week mark.
“Delivery of a supported low-calorie total diet replacement program (Counterweight-Plus) to patients with difficult-to-treat asthma and obesity was safe and led to significant improvements in asthma control and quality of life compared with usual care over 16 weeks,” Varun Sharma, MBChB, honorary clinical lecturer at the Institute of Infection, Immunity and Inflammation at University of Glasgow, and colleagues wrote.
In a single center, open-label, randomized, controlled trial, Sharma and colleagues evaluated 35 adults (mean age, 52.6 years; 62.9% women; 54.3% former smokers) with difficult-to-treat asthma and obesity (BMI 30 kg/m2; median, 37.5 kg/m2) to determine if CWP led to positive changes in patient scores on the Asthma Control Questionnaire 6 (ACQ6) and the Asthma Quality of Life Questionnaire (AQLQ) vs. usual care at 16 weeks.
Of the total cohort, 33 patients had data from a 16-week follow-up visit, including 17 patients who participated in CWP (mean age, 56.7 years; 72.2% women) and 16 patients who received usual care (mean age, 48.3 years; 52.9% women).
Asthma control, quality-of-life changes
At baseline, the mean asthma control score of the total cohort was 2.8 (95% CI, 2.4-3.1), and those following the CWP vs. usual care had a larger significant improvement in this measure at 16 weeks (between group mean difference, –0.69; 95% CI, –1.37 to –0.01).
Further, researchers observed 53% of patients in the CWP group reach the minimal clinically important difference (≥ 0.5 change) in ACQ6 score, compared with only 19% of patients in the usual care group (P = .041).
For asthma quality of life, the mean score of the total cohort at baseline was 3.8 (95% CI, 3.4-4.2). Patients following the CWP also demonstrated larger improvements in quality of life vs. patients receiving usual care at 16 weeks (between group mean difference, 0.76; 95% CI, 0.18-1.34).
This finding continued when researchers evaluated the subgroups that make up the AQLQ score, with those following the CWP showing more positive changes in symptom (between-group mean difference, 0.72; 95% CI, 0.14-1.31; P = .018), activity (0.78; 95% CI, 0.08-1.47P = .029) and environmental domain scores (0.98; 95% CI, 0.01-1.96; P = .048) than those receiving usual care. Unlike ACQ6 scores, AQLQ scores that reached the minimal clinically important difference did not significantly differ between the groups.
Weight loss
Of the total cohort, 101.7 kg was the median weight at baseline. Compared with patients receiving usual care, researchers found that patients participating in CWP demonstrated more weight loss (mean change, –1.4 kg; 95% CI, –3.2 to 0.4 vs. –13.5 kg; 95% CI, –17.5 to –9.6). Additionally, mean BMI of patients in the CWP group dropped by 4.9 kg/m2 (95% CI, –6.3 to –3.5), compared with a drop of 0.3 kg/m2 (95% CI, –1.1 to 0.6) among those in the usual care group.
Improvement was also observed on the Medical Research Council dyspnea scale for those in the CRP group vs. the usual care group with a significant median change in scores (–1; interquartile range [IQR], –1 to 0 vs. 0; IQR, 0-0; P = .004), according to researchers.
When evaluating patients following the CWP in post-hoc analysis according to their percentage of total body weight loss, researchers found that patients with a loss of 10% to 15% showed improved mean changes in ACQ6 (–0.7; 95% CI, –1.6 to 0.3) and AQLQ scores (0.6; 95% CI, –0.1-1.3) at week 16. Notably, patients who lost 15% or more of their body weight had larger changes in ACQ6 (–1.2; 95% CI, –3.1 to 0.7) and AQLQ scores (1.4; 95% CI, –0.8 to 3.6) at week 16, which demonstrates that more improvement in asthma control and quality of life occurs when patients lose more weight.
Although five adults (CWP, n = 2; usual care, n = 3) were admitted into the hospital over this timeframe, each for a different reason, researchers reported “no unexpected serious adverse events or intervention-related adverse events.”
“Initial results using the CWP are encouraging, and adherence to the program was better than expected, although longer-term outcomes are awaited to assess sustainability of the benefits seen,” Sharma and colleagues wrote.
This study by Sharma and colleagues offers a significant contribution to research on patients suffering with asthma and obesity, according to an accompanying editorial by Sarah Diver, PhD, and Ruth H. Green, PhD, both of the department of respiratory sciences at NIHR Leicester Biomedical Research Centre at the University of Leicester.
How such a program can be implemented in a real-world setting needs further study, Diver and Green wrote.
“Weight management strategies such as this fit well into the ‘treatable traits’ model of asthma care that has gained support within the pulmonology community in recent years, and the fact that this program is managed exclusively by experienced dieticians is attractive for both patients and asthma clinicians,” Diver and Green wrote. “However, the number of patients eligible for such an intervention is likely to far exceed the capacity for such regular reviews; therefore, further investigation may be required to understand whether this program can still achieve positive outcomes with less resource-intensive support or, alternatively, to define those subgroups most likely to respond.”
Reference:
Perspective
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Asthma can be difficult to control in patients with obesity, although weight loss has been demonstrated to improve asthma symptoms in prior studies. This study evaluated the effects of utilizing CWP compared with no dietary or lifestyle changes on asthma control and quality-of-life questionnaires. CWP is available in the U.K. and involves utilizing 12 to 20 weeks of total diet replacement, limiting intake to 850 kcal daily via commercial porridge, soup and shake products. This is followed by stepwise food reintroduction and counseling. CWP was used in the DiRECT trial which demonstrated remission of type 2 diabetes with intensive weight loss. The patients in the treatment arm of this study demonstrated significant weight loss with an average of 13.5 kg (29.7 lb); this was associated with improvement in reported asthma control and quality of life at 16 weeks.
It is important to note that this is an extreme dietary and lifestyle modification program, and different diets for the treatment of asthma have not been compared. In the United States, some of the most difficult-to-treat asthma is in people living in urban areas. These areas are often described as “food deserts,” where people have limited access to affordable and healthy foods, especially fresh fruits and vegetables. Total diet replacement with intensive nutrition and lifestyle counseling is likely not available for a lot of our patients with difficult-to-treat asthma.
While we await a study that compares different types of weight loss diets on asthma control, I encourage my patients to make attainable and lifelong changes. Keeping food diaries can be a good way to identify areas where you can cut back. Focusing on not drinking calories — eliminating soda, juice and energy drinks — can significantly decrease caloric intake. It’s important to make an intentional effort to replace processed foods with vegetables and fruits. While this promising research demonstrates proof of concept, we should encourage people with difficult-to-treat asthma to make healthy diet and lifestyle changes that they will be able to maintain lifelong.
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