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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2008; 02(04): 181-186
DOI: 10.1055/s-0037-1618645
Adipositas und Lunge
Schattauer GmbH

Adipositas – Risikofaktor für die Asthmagenese im Kindes- und Jugendalter?

Obesity – risk factor for the development of asthma in children and adolescents?
J. Lecheler
1   CJD Asthmazentrum, Berchtesgaden
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Publication History

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Die Häufigkeit von Adipositas steigt seit einer Generation bei Kindern und Jugendlichen ebenso an wie die Häufigkeit von Asthma bronchiale. Epidemiologische Untersuchungen lassen vermuten, dass es kausale Verknüpfungen zwischen diesen beiden Krankheitsbildern gibt. Die Einschränkungen der Lungenfunktion Adipöser lassen jedoch auch einen anderen Schluss zu: Verminderte Flussraten in der Spirometrie sind nur in Relation zur gleichsinnig verminderten Vitalkapazität zu verstehen und können, absolut genommen, missverständlich als Asthma interpretiert werden. Missverständnisse können auch durch falsche Bewertungen der subjektiv empfundenen Dyspnoe ausgelöst werden. Der pathologischer Ausfall in Hyperreagibilitätstests Adipöser andererseits ist auf funktionelle Veränderung der glatten Muskulatur in den Atemwegen zurückzuführen (“bronchial latching”). Diese adipositasinduzierte bronchiale Dysfunktion bedarf jedoch keiner antiinflammatorischen oder broncho- spasmolytischen Theapie. Körperliches Training und Gewichtsreduktion sind dagegen ein kausaler Behandlungsansatz. Ein passiveres Bewegungsverhalten im Kindes- und Jugendalter mit häufigem Medienkonsum führt nicht nur zur Zunahme von Adipositas, sondern trägt auch zur Asthma-Entwicklung bei. Adipositas und Asthma sind dabei unabhängig voneinander Folgen einer gemeinsamen Ursache, können sich später jedoch ungünstig verstärken.

Summary

For a generation, the incidence of obesity has been increasing in children and adolescents just like the incidence of asthma. Epidemiological studies have suggested causal associations between these two diseases. However, a different conclusion may be drawn from the impairments in lung function in obese patients: unless there are also reductions in vital capacity, reduced spirometric flow rates are, by themselves, not conclusive and can be misinterpreted as asthma. Misunderstandings can also be triggered by incorrect assessments of the subjective symptom of dyspnoea. On the other hand, the pathological deficit seen in hyperreactivity tests of obese patients is due to functional changes in smooth muscles of the respiratory tract (“bronchial latching”). This obesity-induced bronchial dysfunction does not however require any anti-inflammatory or bronchospasmolytic therapy. Instead, physical training and weight reduction are a causal approach to treatment. A more sedentary lifestyle in children and adolescents, with frequent media consumption, not only leads to an increase in obesity but also contributes to the development of asthma. Obesity and asthma are therefore independent consequences of one and the same cause but which can exacerbate each other later on.

Schlüsselwörter

dipositas - Asthma bronchiale - sedentary lifestyle - adi- positasinduzierte respiratorische Dysfunktion

Keywords

Obesity - bronchial asthma - sedentary lifestyle - obesity-induced respiratory dysfunction
 

  • Literatur

  • 1 Wabitsch M. Adipositas bei Kindern und Jugendlichen in Deutschland. Deutliche und anhaltende Zunahme der Prävalenz – Aufruf zum Handeln. Fortschr Med Orig 2002; 5; 120 (04) 99-106.
    PubMedGoogle Scholar
  • 2 v. Mutius E, Martinez F. Childhood Asthma. In: Murphy S, Kelly H. Pediatric Asthma. New York: Dekker; 1999: 1-39.
    Google Scholar
  • 3 Chinn et al. Can the increase in body mass index explain the rising trend in asthma in children?. Thorax 2001; 56: 845-850.
    CrossrefPubMedGoogle Scholar
  • 4 Somerville S, Rona R, Chinn S. Obesity and respiratory symptoms in primary school. Arch Dis Child 1984; 59: 940-944.
    CrossrefPubMedGoogle Scholar
  • 5 Luder E, Melnik T, DiMaio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children. J Pediatr 1998; 132: 699-703.
    CrossrefPubMedGoogle Scholar
  • 6 Genuso J, Epstein L, Paluch R, Cerny F. The relationship between asthma and obesity in urban minority children and adolescents. Arch Pediatr Adolesc Med 1998; 152: 1197-1200.
    PubMedGoogle Scholar
  • 7 Chen Y, Dales R, Krewski D, Breithaupt K. Increased effects of smoking and obesity on asthma among female Canadians; the National Population Health Survey. Am J Epidemiol 1999; 150: 255-262.
    CrossrefPubMedGoogle Scholar
  • 8 Kim S. et al. Sex-race differences in relationsship between obesity and asthma. Ann Epidemiol 2003; 13: 666-673.
    CrossrefPubMedGoogle Scholar
  • 9 Schachter L, Salome C, Peat J, Woolcock A. Obesity is a risk factor for asthma and wheeze but not airway hyperresponsiveness. Thorax 2001; 56: 4-8.
    CrossrefPubMedGoogle Scholar
  • 10 Dixon J. et al. Marked improvement in asthma after Lap-Band Surgery for morbid obesity. Obes surg 1999; 04: 385-389.
    PubMedGoogle Scholar
  • 11 Legere et al. Pulmonary function in obesity. Resp Care 2000; 45 (08) 967-968.
    PubMedGoogle Scholar
  • 12 Li AM, Chan D. et al. The effects of obesity on pulmonary function. Arch Dis Child 2003; 88 (04) 361-363.
    CrossrefPubMedGoogle Scholar
  • 13 Inselma LS, Milanese A. et al. Effect of obesity on pulmonary function in children. Pediatr Pulmonol 1993; 16 (02) 130-137.
    CrossrefPubMedGoogle Scholar
  • 14 Pelosi P, Croci M. et al. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 1996; 109 (01) 144-151.
    CrossrefPubMedGoogle Scholar
  • 15 Sood R, Mount DL. et al. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Plast Reconstr Surg 2003; 111 (02) 688-694.
    CrossrefPubMedGoogle Scholar
  • 16 Canoy D, Luben R. et al. Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, UK. Am J Epidemiol 2004; 159 (12) 1140-1149.
    CrossrefPubMedGoogle Scholar
  • 17 De Lorenzo A, Maiolo C. et al. Body composition analysis and changes in airways function in obese adults after hypocaloric diet. Chest 2001; 119 (05) 1409-1415.
    CrossrefPubMedGoogle Scholar
  • 18 Lazarus R, Colditz G. et al. Effects of body fat on ventilatory function in children and adolescents: cross-sectional findings from a random population sample of school children. Pediatr Pulmonol 1997; 24 (03) 187-194.
    CrossrefPubMedGoogle Scholar
  • 19 Ray CS, Sue DY. et al. Effects of obesity on respiratory function. Am Rev Respir Dis 1983; 128 (03) 501-506.
    CrossrefPubMedGoogle Scholar
  • 20 Chen Y, Horne SL. et al. Body weight and weight gain related to pulmonary function decline in adults: a six year follow up study. Thorax 1993; 48 (04) 375-380.
    CrossrefPubMedGoogle Scholar
  • 21 Sin DD. et al. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med 2002; 162: 1477-1481.
    CrossrefPubMedGoogle Scholar
  • 22 Berdel D, Forster J, Gappa M. et al. Leitlinie zum Asthma bronchiale im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2007; 155: 957-967.
    CrossrefPubMedGoogle Scholar
  • 23 Lecheler J, Egmond-Frohlich A. Die Adipositasinduzierte respiratorische Dysfunktion bei Kindern und Jugendlichen. Dtsch Med Wochenschr 2006; 131 (08) 393-397.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Molnar D, Schutz Y. The effect of obesity, age, puberty and gender on resting metabolic rate in children and adolescents. Eur J Pediatr 1997; 156 (05) 376-381.
    CrossrefPubMedGoogle Scholar
  • 25 Rivera RClaros, Marin V. et al. Nutritional status and clinical evolution of hospitalized Chilean infants with infection by respiratory syncytial virus (RSV). Arch Latinoam Nutr 1999; 49 (04) 326-332.
    PubMedGoogle Scholar
  • 26 Fredberg J, Inouye DS, Mijailovich SM. Perturbed equilibrium of myosin binding in airway smooth muscle and its implication in bronchospasm. AJRCCM 1999; 159: 959-967.
    PubMedGoogle Scholar
  • 27 McClean MA, Matheson MJ. et al. Low lung volume alters contractile properties of airway smooth muscle in sheep. Eur Respir J 2003; 22 (01) 50-56.
    CrossrefPubMedGoogle Scholar
  • 28 Biring MS, Lewis MI. et al. Pulmonary physiologic changes of morbid obesity. Am J Med Sci 1999; 318 (05) 293-297.
    CrossrefPubMedGoogle Scholar
  • 29 Loftin M, Sothern M. et al. Scaling VO(2) peak in obese and non-obese girls. Obes Res 2001; 09 (05) 290-296.
    CrossrefPubMedGoogle Scholar
  • 30 Wang LY, Cerny FJ. Ventilatory response to exercise in simulated obesity by chest loading. Med Sci Sports Exerc 2004; 36 (05) 780-786.
    CrossrefPubMedGoogle Scholar
  • 31 Walter U, Kramer S, Robl M. Körperliche (In)Aktivitat in Kindheit und Jugend. Dtsch Med Wochenschr 2005; 130 (50) 2876-2878.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Deutscher Sportbund. WIAD-AOK-DSB-Studie II. Bewegungsstatus von Kindern und Jugendlichen in Deutschland. 2003
    PubMedGoogle Scholar
  • 33 Starker A, Lampert T, Schlack R. et al. Motorische Leistungsfähigkeit. In: Bundesgesundheitsblatt – 2007 (i. D.)..
    PubMedGoogle Scholar
  • 34 Dennison B, Erb TA, Jenkins PL. TV-viewing and TV in bedroom associated with overweight risk among low-incom preschool children. Pediatrics 2002; 109: 1028-1035.
    CrossrefPubMedGoogle Scholar
  • 35 Lecheler J, Biberger A, Pfannebecker B. Asthma und Sport. Berchtesgaden: INA; 2006
    Google Scholar
  • 36 Ford S. et al. Leisure time Physical Activity Patterns Among US Adults with Asthma. J Asthma 2004; J Asthma 2005; 42: 91-95.
    PubMedGoogle Scholar
  • 37 Rasmussen F. et al. Low physical fitness in childhood is associated with the development of asthma. Eur Resp J 2000; 16: 866-870.
    CrossrefPubMedGoogle Scholar
  • 38 Huovinen E, Kaprio J, Koskenvuo M. Factors associated to lifestyle and risk of adult onset asthma. Respir Med 2003; 97 (03) 273-280.
    CrossrefPubMedGoogle Scholar
  • 39 WHO. Obesity: preventing and managing the global epidemic. WHO Technical Report Series. 894. Genf 2000
    PubMedGoogle Scholar
  • 40 Salmon J, Timperio A, Telford A. Association of family environment with children’s television viewing and with low level of physical activity. Obes Res 2005; 13 (11) 1939-1951.
    CrossrefPubMedGoogle Scholar
  • 41 Hark WT, Thompson WM, McLaughlin TE. Spontaneous sigh rates during sedentary activity. Ann Allergy Asthma Immunol 2005; 94: 247-250.
    CrossrefPubMedGoogle Scholar