Obezite ve Solunum Sistemi

Obezitenin prevalansı son 30 yıldır dramatik bir şekilde artmaktadır. Obezite solunum fonksiyonlarının çeşitli anormallikleriyle ilişkilidir ve azalmış akciğer volümleriyle sonuçlanan solunum sistemi mekaniklerindeki değişikliklerle karakterizedir. Obezite ile kronik solunum sistemi hastalıkları arasındaki bağlantı giderek daha fazla fark edilmeye başlanmıştır. Obezite, obstrüktif uyku apne sendromu ve obezite hipoventilasyon sendromu gelişmesinde anahtar rol oynar. Ayrıca, astım obez popülasyonda daha sık görülür ve bu hasta gurubunda astımın tedavisi zordur. Bu yazıda, obezite-nin astım, kronik obstrüktif akciğer hastalığı, obstrüktif uyku apne sendromu ve obezite hipoventilasyon sendromu gibi kronik solunum yolu hastalık-ları üzerindeki etkisini gözden geçirdik.

Obesity and Respiratory System

The prevalence of obesity has increased dramatically over the the last 30 years. Obesity is associated with several abnormalities of respiratory func-tion. It’s characterized by altered respiratory system mechanics, resulting in decreased lung volumes. A link between obesity and chronic respiratory diseases is also increasingly recognized. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndro-me. Asthma is more common and often harder to treat in the obese population. In this article, we review the current understanding of the influence of obesity on chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease, obstructive sleep apnea and obesity hypoventilation syndrome.

PDF

___

Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief 2015; 219: 1-8.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evalu-ation, and effect of weight loss. Arterioscler Thromb Vasc Biol 2006; 26: 968-76.
Zammit C, Liddicoat H, Moonsie I, et al. Obe-sity and respiratory diseases. Int J Gen Med 2010; 3: 335-43.
Franssen FM, O'Donnell DE, Goossens GH, et al. Obesity and the lung: 5. Obesity and COPD. Thorax 2008; 63: 1110-7.
Watson RA, Pride NB, Thomas EL, et al. Re-duction of total lung capacity in obese men: comparison of total intrathoracic and gas volu-mes. J Appl Physiol 2010; 108: 1605-12.
Behazin N, Jones SB, Cohen RI, et al. Respira-tory restriction and elevated pleural and esopha-geal pressures in morbid obesity. J Appl Physiol 2010; 108: 212-8.
Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest 2006; 130: 827-33.
Peters U, Suratt BT, Bates JHT, et al. Beyond BMI: Obesity and lung disease. Chest 2018; 153: 702-9.
Sood A. Altered resting and exercise respiratory physiology in obesity. Clin Chest Med 2009; 30: 445–54.
Littleton SW. Impact of obesity on respiratory function. Respirology 2012; 17: 43-9.
Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory func-tion: the normative aging study. Chest 1997; 111: 891-8.
Burki NK, Baker RW. Ventilatory regulation in eucapnic morbid obesity. Am Rev Respir Dis 1984; 129: 538-43.
Sampson MG, Grassino AE. Load compensa-tion in obese patients during quiet tidal breat-hing. J Appl Physiol 1983; 55: 1269-76.
Pankow W, Podszus T, Gutheil T, et al. Expira-tory flow limitation and intrinsic positive end-expiratory pressure in obesity. J Appl Physiol 1998; 85: 1236-43.
Chlif M, Keochkerian D, Choquet D, et al. Ef-fects of obesity on breathing pattern, ventilatory neural drive and mechanics. Respir Physiol Ne-urobiol 2009; 168: 198-202.
Pelosi P, Croci M, Ravagnan I, et al. Total respiratory system, lung, and chest wall mecha-nics in sedated-paralyzed postoperative mor-bidly obese patients. Chest 1996; 109: 144-51.
Zerah F, Harf A, Perlemuter L, et al. Effects of obesity on respiratory resistance. Chest 1993; 103: 1470-6.
Iftikhar IH, Roland J. Obesity Hypoventilation Syndrome. Clin Chest Med 2018; 39: 427-36.
Nowbar S, Burkart KM, Gonzales R, et al. Obe-sity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med 2004; 116: 1-7.
Manuel ARG, Hart N, Stradling JR. Is a raised bicarbonate, without hypercapnia, part of the physiologic spectrum of obesity-related hypo-ventilation? Chest 2015; 147: 362-8.
Greenburg DL, Lettieri CJ, Eliasson AH. Ef-fects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 2009; 122: 535-42.
Hollier CA, Harmer AR, Maxwell LJ, et al. Moderate concentrations of supplemental oxy-gen worsen hypercapnia in obesity hypoventila-tion syndrome: a randomised crossover study. Thorax 2014; 69: 346-53.
Lam JC, Mak JC, Ip MS. Obesity, obstructive sleep apnoea and metabolic syndrome. Respiro-logy 2012; 17: 223-36.
Türk Toraks Derneği Obstrüktif Uyku Apne Sendromu Tanı ve Tedavi Uzlaşı Raporu 2012. Rapor Editörü: Çiftçi TU. Türk Toraks Dergisi. 2012; 13 (Ek-1).
Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004; 291: 2013-6.
Lopez PP, Stefan B, Schulman CI, et al. Preva-lence of sleep apnea in morbidly obese patients who presented for weight loss surgery evalua-tion: more evidence for routine screening for obstructive sleep apnea before weight loss sur-gery. Am Surg 2008; 74: 834-8.
Ayık SÖ, Akhan G, Peker Ş. Obstruktif uyku apne sendromlu (OSAS) olgularda obezite sıklı-ğı ve ek hastalıklar. Türk Toraks Dergisi 2011; 12: 105-10.
Ogilvie RP, Patel SR. The epidemiology of sleep and obesity. Sleep Health 2017; 3: 383-8.
Peppard PE, Young T, Barnet JH, et al. Increa-sed prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177: 1006-14.
Newman AB, Foster G, Givelber R, et al. Prog-ression and regression of sleep-disordered bre-athing with changes in weight: the sleep heart health study. Arch Intern Med 2005; 165: 2408-13.
Tishler PV, Larkin EK, Schluchter MD, et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003; 289: 2230-7.
Mitchell LJ, Davidson ZE, Bonham M, et al. Weight loss from lifestyle interventions and se-verity of sleep apnoea: a systematic review and meta-analysis. Sleep Med 2014; 15: 1173-83.
Drager LF, Brunoni AR, Jenner R, et al. Effects of CPAP on body weight in patients with obst-ructive sleep apnoea: a metaanalysis of rando-mised trials. Thorax 2015; 70: 258-64.
Ataç E, Yıldırım G, Kumral TL ve ark. . Obst-rüktif uyku apne sendromu ve obezite. Okmey-danı Tıp Dergisi 2104; 30 (Ek-1): 19-23.
Scanlan MF, Roebuck T, Little PJ, et al. Effect of moderate alcohol upon obstructive sleep ap-noea. Eur Respir J 2000; 16: 909-13.
Kashyap R, Hock LM, Bowman TJ. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath 2001; 5: 167-72. 37. Laratta CR, Ayas NT, Povitz M, et al. Diagno-sis and treatment of obstructive sleep apnea in adults. CMAJ 2017; 189: E1481-88.
Farah CS and Salome CM. Asthma and obesity: A known association but unknown mechanism. Respirology 2012; 17: 412-21.
Carpaij OA, van den Berge M. The asthma–obesity relationship: underlying mechanisms and treatment implications. Curr Opin Pulm Med 2018; 24: 42-9.
Peters U, Dixon AE, Forno E. Obesity and Asthma. J Allergy Clin Immunol 2018; 141: 1169-79.
Sutherland ER, Lehman EB, Teodorescu M, Wechsler ME; National Heart, Lung, and Blood Institute’s Asthma Clinical Research Network. Body mass index and phenotype in subjects with mild-to-moderate persistent asthma. J Al-lergy Clin Immunol 2009; 123: 1328–34.
Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruc-tion. Arch Intern Med 2002; 162: 1477-81.
Farah CS, Kermode JA, Downie SR, et al. Obe-sity is a determinant of asthma control indepen-dent of inflammation and lung mechanics. Chest 2011; 140: 659-66.
Shore SA, Johnston RA. Obesity and asthma. Pharmacology & Therapeutics 2006; 110: 83-102.
Nicolacakis K, Skowronski ME, Coreno AJ, et al. Observations on the physiological interacti-ons between obesity and asthma. J Appl Physiol 2008; 105: 1533-41.
Beuther DA. Recent insight into obesity and asthma. Curr Opin Pulm Med 2010; 16: 64-70.
Nakajima K, Kubouchi Y, Muneyuki T, Ebata M, Equchi S, Munakata H. A possible associa-tion between suspected restrictive pattern as as-sessed by ordinary pulmonary function test and the metabolic syndrome. Chest 2008; 134: 712-8.
Litonjua AA, Sparrow D, Celedon JC, DeMol-les D, Weiss ST. Association of body mass in-dex with the development of methacholine airway hyperresponsiveness in men: the Norma-tive Aging Study. Thorax 2002; 57: 581-5.
Ciprandi G1, Pistorio A, Tosca M, Ferraro MR, Cirillo I. Body mass index, respiratory function and bronchial hyperreactivity in allergic rhinitis and asthma. Respir Med 2009; 103: 289-95.
Mansell AL, Walders N, Wamboldt MZ, et al. Effect of body mass index on response to met-hacholine bronchial provocation in healthy and asthmatic adolescents. Pediatr Pulmonol 2006; 41: 434-40.
Holguin F, Bleecker ER, Busse WW, et al. Obesity and asthma: an association modified by age of asthma onset. J Allergy Clin Immunol 2011; 127: 1486-93.
McClean KM, Kee F, Young IS, Elborn JS. Obesity and the lung:1. Epidemiology. Thorax 2008; 63: 649-54.
Ochs-Balcom HM, Grant BJ, Muti P, et al. Pulmonary function and abdominal adiposity in the general population. Chest 2006; 129: 853-62.
Steuten LM, Creutzberg EC, Vrijhoef HJ, Wou-ters EF. COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. Prim Care Respir J 2006; 15: 84-91.
Cao C, Wang R, Wang J, Bunjhoo H, Xu Y, Xiong W. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One 2012; 7: e43892.
Galesanu RG, Bernard S, Marquis K, et al. Obesity in chronic obstructive pulmonary disea-se: is fatter really better? Can Respir J 2014; 21: 297-301.
King GG, Brown NJ, Diba C, et al. The effects of body weight on airway calibre. Eur Respir J 2005; 25: 896-901.
McNicholas WT. Chronic obstructive pulmo-nary disease and obstructive sleep apnea. Am J Respir Crit Care Med 2009; 180: 692-700.

ISSN: 1300-9818
Başlangıç: 2015
Yayıncı: Fırat Üniversitesi Tıp Fakültesi

Arşiv