D1.94 - Impact of overweight and obesity on clinical remission and Response to Biologics in Severe Asthma Patients

Obesity worsens asthma outcomes like poor symptom control and quality of life. Advances in biologics have improved asthma outcomes in severe asthma patients with ambition of achieving clinical remission. This study evaluates the impact of obesity on biologics in terms of clinical response and remission in severe asthma patients.

A prospective study of 133 adult severe asthma patients from Kuwait National Severe Asthma Registry. We assessed the impact of Body Mass Index (BMI) on biological outcomes over 12 months. Patients were stratified into four BMI groups: normal weight (<25), overweight (25–29.9), mild/moderate obesity (30–39.9), and morbid obesity (>40). Clinical remission was defined as no exacerbations, no oral corticosteroids (OCS) use, ACT score ≥20, ACQ-6 score ≤0.75, and Pre-bronchodilator FEV1 ≥80%. Collected data included demographics, clinical outcomes, BEC, total IgE, FeNO, and IL-4/IL-6 gene polymorphisms.

Two-thirds of patients were female (68.9%) with an average age of 54.09 years, most of whom had adult-onset asthma (67.3%) and frequent exacerbations (median: 4/year). Only 9% maintained a normal weight, while 24% were overweight, 46.6% had mild to moderate obesity, and 20.3% were morbidly obese. Biologics improved asthma symptoms and lung function across all groups (p<0.001). However, morbidly obese patients had worse ACT and ACQ-6 scores, poor lung function, and higher exacerbations and OCS use rates (p<0.05). The IL-4 TT and IL-6 GG genotype were linked to an increased risk of morbid obesity. Clinical remission was achieved in 17.29% of patients; 25% in normal-weight patients compared to 11% in morbidly obese group. Age reduced the likelihood of remission in overweight and obese patients (OR 0.95, p=0.02), while the IL-4 CC genotype increased remission likelihood (OR 2.48, p=0.04).

Obesity worsens asthma outcomes, with morbidly obese patients experiencing poorer symptom control, higher exacerbations and OCS use, and reduced lung function despite biologics. The IL-4 TT and IL-6 GG genotypes are linked to morbid obesity, while the IL-4 CC genotype favors clinical remission. Older age reduces the likelihood of remission in overweight and obese patients, emphasizing the need for a personalized asthma management.