PATHOPHYSIOLOGICAL AND CLINICAL CORRELATIONS BETWEEN BRONCHIAL ASTHMA AND METABOLIC SYNDROME: A REVIEW

Abstract

Introduction: Bronchial asthma (BA) and obesity represent significant challenges in contemporary medicine, with escalating prevalence in developed nations. This review aims to systematically analyze the pathophysiological and clinical interplay between bronchial asthma and metabolic syndrome, emphasizing their role in severe asthma development. Search strategy: A thorough literature search was conducted up to May 10, 2024, using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials. The search spanned the past decade and employed predefined keywords based on Medical Subject Headings (MeSH). Inclusion criteria encompassed studies meeting evidence-based medicine standards and fundamental experimental research, published in English or Russian. Exclusion criteria included clinical case descriptions, non-evidence-based publications, and abstracts. Results: This review synthesizes current insights into the mechanisms underlying the association between bronchial asthma and metabolic syndrome. A conventional perspective links asthma and the syndrome through mechanical effects of abdominal adipose tissue, impacting respiratory tract resistance and volumes. Furthermore, emphasis is placed on metabolic dysregulation's role in altering proinflammatory cytokine levels and adipose tissue hormone profiles. The review also introduces the concept of a metabolic phenotype in asthma, characterizing it as an independent variant within the spectrum of "bronchial asthma – metabolic syndrome - obesity." Pathogenetic relationships involving insulin resistance, hyperinsulinemia's epithelial effects on the respiratory tract, chronic inflammation, and respiratory hyperreactivity are highlighted. Conclusions: The findings support a clinical and pathophysiological framework distinguishing a distinct "metabolic phenotype" in asthma patients. This phenotype underscores the interconnected pathogenesis involving insulin resistance, chronic inflammation, and heightened respiratory tract reactivity. Such insights contribute to advancing targeted therapeutic approaches for this subset of patients.