Bronchial asthma and obesity: features of systemic inflammation depending on the time of asthma onset

BACKGROUND: Bronchial asthma (asthma) is a complex, heterogeneous, multifactorial chronic disease. The pathophysiological mechanisms of the interaction between asthma and obesity have attracted considerable attention. AIM: The work aimed to assess the characteristics of the cytokine profile in patients with asthma and obesity depending on the time of asthma onset. METHODS: A total of 180 individuals were examined: 150 patients with asthma of varying severity were stratified by body mass index and divided into two study groups: those with a body mass index of 18.5–25 kg/m2 (n = 52, Asthma group) and those with a body mass index of 30–35 kg/m2 (n = 98). The control group consisted of 30 individuals. Patients with asthma and obesity (body mass index 30 kg/m2) were further subdivided into two groups according to the time of asthma onset: Obesity + Asthma and Asthma + Obesity (with asthma duration of approximately 10 years). Asthma severity was assessed using the Asthma Control Test (ACT) and the Asthma Control Questionnaire (ACQ-5). Spirometry with bronchodilator testing was performed, and venous blood was collected to determine cytokine profile parameters (tumor necrosis factor-alpha; interleukins IL-2, IL-4, IL-6, IL-8, IL-10, IL-17; interferon-gamma) and markers of systemic inflammation (C-reactive protein, fibrinogen). RESULTS: The asthma–obesity phenotype was characterized by a more severe course and poorer disease control, with the Obesity + Asthma group showing the most pronounced bronchial obstruction. Analysis of the cytokine profile revealed a significant imbalance between proinflammatory and anti-inflammatory cytokines, most pronounced in the Obesity + Asthma group. The findings underscore the importance of determining cytokine ratio indices with opposing activities (IL-2/IL-4, IL-2/IL-10, IL-8/IL-10, IL-6/IL-10, tumor necrosis factor-alpha/IL-10) to assess the severity of the inflammatory process and guide treatment strategies. CONCLUSION: Obesity contributes to the development and maintenance of systemic inflammation, aggravating the course and progression of asthma.