The interconnection between Obesity and Asthma-Obstructive Sleep Apnea Overlap: A Comprehensive Review

1 Tsuneto A, Yuichi I, Naohisa U, Shin-Ichi M. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020 Sleep Apnea Syndrome (SAS) Respir Investig. 2022 Jan;60(1):3-32. doi:10.1016/j.resinv.2021.08.010.https(PubMed). Search in Google Scholar

2 Word Health Organization. Obesity and overweight. June 2021. Search in Google Scholar

3 Yael Mauer, Rachel Metzger Taliercio; Managing adult asthma: The 2019 GINA guidelines. Cleve Clin J Med 2020 Aug 31;87(9):569-575. doi: 10.3949/ccjm.87a.19136. Search in Google Scholar

4 Shrestha B., Mukhtar O., Kandel S., Bhattrai B., Dattar P., Amgai B., Mandal A., Alhafidh O., Thapa S., Khalid M., et al. Polysomnographic Variables in Alternate Overlap Syndrome: Data from Sleep Heart Health Study. J. Community Hosp. Intern. Med. Perspect. 2019;9:108–112. doi: 10.1080/20009666.2019.1 595951. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

5 Wang D., Zhou Y., Chen R., Zeng X., Zhang S., Su X., Luo Y., Tang Y., Li S., Zhuang Z., et al. The Relationship between Obstructive Sleep Apnea and Asthma Severity and Vice Versa: A Systematic Review and Meta-Analysis. Eur. J. Med. Res. 2023;28:139. doi: 10.1186/s40001-023-01097-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

6 Knuiman M., James A., Divitini M., Bartholomew H. Longitudinal Study of Risk Factors for Habitual Snoring in a General Adult Population: The Busselton Health Study. Chest. 2006;130:1779–1783. doi: 10.1378/chest.130.6.1779. [PubMed] [Cross- Ref] [Google Scholar] [Ref list]. Search in Google Scholar

7 Janson C., De Backer W., Gislason T., Plaschke P., Björnsson E., Hetta J., Kristbjarnarson H., Vermeire P., Boman G. Increased Prevalence of Sleep Disturbances and Daytime Sleepiness in Subjects with Bronchial Asthma: A Population Study of Young Adults in Three European Countries. Eur. Respir. J. 1996;9:2132–2138. doi: 10.1183/09031936.96.09102132. [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

8 Puthalapattu S., Ioachimescu O.C. Asthma and Obstructive Sleep Apnea: Clinical and Pathogenic Interactions. J.Investig. Med. 2014;62:665–675. doi: 10.2310/JIM.0000000000000065. [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

9 Ragnoli B., Pochetti P., Raie A., Malerba M. Interrelationship Between Obstructive Sleep Apnea Syndrome and Severe Asthma: From Endo-Phenotype to Clinical Aspects. Front. Med. 2021;8:640636. doi: 10.3389/fmed.2021.640636. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

10 Prasad B., Nyenhuis S.M., Imayama I., Siddiqi A., Teodorescu M. Asthma and Obstructive Sleep Apnea Overlap: What Has the Evidence Taught Us? Am. J. Respir. Crit. Care Med. 2020;201:1345–1357. doi: 10.1164/rccm.201810-1838TR. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

11 Kong D.-L., Qin Z., Shen H., Jin H.-Y., Wang W., Wang Z.-F. Association of Obstructive Sleep Apnea with Asthma: A Meta- Analysis. Sci. Rep. 2017;7:4088. doi: 10.1038/s41598-017-04446-6. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

12 Bonsignore M.R., Pepin J.-L., Anttalainen U., Schiza S.E., Basoglu O.K., Pataka A., Steiropoulos P., Dogas Z., Grote L., Hedner J., et al. Clinical Presentation of Patients with Suspected Obstructive Sleep Apnea and Self-Reported Physician-Diagnosed Asthma in the ESADA Cohort. J. Sleep Res. 2018;27:e12729. doi: 10.1111/jsr.12729. [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

13 Julien J.Y., Martin J.G., Ernst P., Olivenstein R., Hamid Q., Lemière C., Pepe C., Naor N., Olha A., Kimoff R.J. Prevalence of Obstructive Sleep Apnea-Hypopnea in Severe versus Moderate Asthma. J. Allergy Clin. Immunol. 2009;124:371–376. doi: 10.1016/j.jaci.2009.05.016. [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

14 Teodorescu M., Barnet J.H., Hagen E.W., Palta M., Young T.B., Peppard P.E. Association between Asthma and Risk of Developing Obstructive Sleep Apnea. JAMA. 2015;313:156–164. doi: 10.1001/jama.2014.17822. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

15 Damini Saxena, Ikuyo Imayama, and Muhammad Adrish Miguel Angel Martinez-Garcia, Academic Editor. J Clin Med. 2023 Oct; 12(20):6552.doi: 10.3390/jcm12206552 PMCID: PMC10607310 PMID: 37892689. Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs Search in Google Scholar

16 Taylor B, Mannino D, Brown C, Crocker D, Twum-Baah N, Holguin F. Body mass index and asthma severity in the National Asthma Survey. Thorax. 2008;63(1):14–20. doi: 10.1136/thx.2007.082784 [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

17 Larsson SC, Burgess S. Causal role of high body mass index in multiple chronic diseases: a systematic review and meta-analysis of Mendelian randomization studies. BMC Med. 2021;19(1):320. doi: 10.1186/s12916-021-02188-x [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

18 Liu Y, Qu HQ, Qu J, et al. The burden of rare coding variants reveals genetic heterogeneity between obese and non-obese asthma patients in the African-American population. Respir Res. 2022;23(1):116. doi: 10.1186/s12931-022-02039-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

19 Murphy A, Tantisira KG, Soto-Quirós ME, et al. PRKCA: a positional candidate gene for body mass index and asthma. Am J Hum Genet. 2009;85(1):87–96. doi: 10.1016/j.ajhg.2009.06.011 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

20 Tomita Y, Fukutomi Y, Irie M, et al. Obesity, but not metabolic syndrome, is a risk factor for late-onset asthma in Japanese women. Allergol Int Off J Jpn Soc Allergol. 2019;68(2):240–246. doi: 10.1016/j.alit.2018.10.003 [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

21 Chen Z, Salam MT, Alderete TL, et al. Effects of Childhood Asthma on the Development of Obesity among School-aged Children. Am J Respir Crit Care Med. 2017;195(9):1181–1188. doi: 10.1164/rccm.201608-1691OC [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

22 Stratakis N, Garcia E, Chandran A, et al. The Role of Childhood Asthma in Obesity Development: A Nationwide US Multicohort Study. Epidemiol Camb Mass. 2022;33(1):131–140. doi: 10.1097/EDE.0000000000001421 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

23 Moitra S, Carsin AE, Abramson MJ, et al. Long-term effect of asthma on obesity among adults: an international cohort study, ECRHS. Thorax. Published online April 27, 2022:thoraxjnl-2021–217867. doi: 10.1136/thoraxjnl-2021-217867 [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

24 Krzysztof Wyszomirski, Maciej Walędziak, Anna Różańska-Walędziak, Bariatric Surgery and Obstructive Sleep Apnea137 Antohi et al.: The interconnection between Obesity and Asthma A Narrative Literature Review. Medicina (Kaunas). 2023 Jul 7;59(7):1266. doi: 10.3390/medicina59071266. Obesity. Search in Google Scholar

25 Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175:661–666. [PMC free article] [PubMed] [Google Scholar]. Search in Google Scholar

26 Dixon AE, Holguin F, Sood A, Salome CM, Pratley RE, Beuther DA, et al. American Thoracic Society Ad Hoc Subcommittee on Obesity and Lung Disease. An official American Thoracic Society Workshop report: obesity and asthma. Proc Am Thorac Soc. 2010;7:325–335. [PubMed] [Google Scholar]. Search in Google Scholar

27 Kasasbeh A, Kasasbeh E, Krishnaswamy G. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex: a hypothetical review. Sleep Med Rev. 2007;11:47–58. [PubMed] [Google Scholar]. Search in Google Scholar

28 Avallone KM, McLeish AC. Asthma and aerobic exercise: a review of the empirical literature. J Asthma. 2013;50:109–116. [PubMed] [Google Scholar]. Search in Google Scholar

29 Teodorescu M, Polomis DA, Gangnon RE, Consens FB, Chervin RD, Teodorescu MC. Sleep duration, asthma, and obesity. J Asthma. 2013;50:945–953. [PMC free article] [PubMed] [Google Scholar] [Ref list]. Search in Google Scholar

30 Shore SA, Johnston RA. Obesity and asthma. Pharmacol Ther. 2006;110:83–102. [PubMed] [Google Scholar] [Ref list]. Search in Google Scholar

31 Larsson, S. C., & Burgess, S. (2021). Mendelian randomization studies and de novo analyses within the FinnGen consortium: Exploring the causal correlation between higher BMI and chronic diseases, including asthma. Search in Google Scholar

32 Peisong Gao, and Georgia M. Dunston (2006). African Americans with Asthma Genetic Insights 2006 (ATSjournals.org) Search in Google Scholar

33 Amy Murphy,1,3,4,6 Kelan G. Tantisira, 1,2,3,4,6 Manuel E. Soto-Quiro’s, 5 Lydiana Avila, 5, Barbara J. Klanderman, 1,3,4 Stephen Lake,1 Scott T. Weiss,1,2,3,4 and Juan C. Celedo ´ n1,2,3,4, Am J Hum Genet(2009). PRKCA: A Positional Candidate Genefor Body Mass Index and Asthma. Search in Google Scholar

34 Zhanghua Chen 1, Muhammad T. Salam 1,2, Tanya L. Alderete 1, Rima Habre 1, Theresa M.Bastain 1, Kiros Berhane 3, and Frank D. Gilliland 1 (2016). Effects of Childhood Asthma on the Development of Obesity among School-aged Children\. Search in Google Scholar

35 Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47–112. [PMC free article] [PubMed] [Google Scholar] [Ref list]. Search in Google Scholar

36 Bharati Prasad, Sharmilee M. Nyenhuis, Ikuyo Imayama, Aminaa Siddiqi, and Mihaela Teodorescu Author information Article notes Copyright and License information PMC Disclaimer Asthma and Obstructive Sleep Apnea Overlap: What Has the Evidence Taught Us? Search in Google Scholar

37 Emilsson OI, Bengtsson A, Franklin KA, Torén K, Benediktsdóttir B, Farkhooy A, et al. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study. Eur Respir J. 2013;0 Scholar] [Ref list]. Search in Google Scholar

38 Meduri GU, Cook TR, Turner RE, Cohen M, Leeper KV. Noninvasive positive pressure ventilation in status asthmaticus. Chest 1996;110:767e74. Search in Google Scholar

39 Lim WJ, Mohammed Akram R, Carson KV, Mysore S, Labiszewski NA,Wedzicha JA, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. CochraneDatabase Syst Rev 2012;12:CD004360. Search in Google Scholar

40 Bledsoe BE, Anderson E, Hodnick R, Johnson L, Johnson S, Dievendorf E. Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehosp Emerg Care 2012;16:217e21. Search in Google Scholar

41 Yim S, Fredberg JJ, Malhotra A. Continuous positive airway pressure for asthma: not a big stretch? Eur Respir J 2007;29:226e8. Search in Google Scholar

42 Pellegrino R, Pellegrino GM, Brusasco V. CPAP as a novel treatment for bronchial asthma? J Appl Physiol 2011;111:343e4. Search in Google Scholar

43 Shepherd KL, James AL, Musk AW, Hunter ML, Hillman DR, Eastwood PR. Gastro-oesophageal reflux symptoms are related to the presence and severity of obstructive sleep apnoea. J Sleep Res 2011;20:241e9. Search in Google Scholar

44 Xue Z, Zhang L, Liu Y, Gunst SJ, Tepper RS. Chronic inflation of ferret lungs with CPAP reduces airway smooth muscle contractility in vivo and in vitro. J Appl Physiol 2008;104:610e5. Search in Google Scholar

45 Xue Z, Yu Y, Gao H, Gunst SJ, Tepper RS. Chronic continuous positive airway pressure (CPAP) reduces airway reactivity in vivo in an allergen-induced rabbit model of asthma. J Appl Physiol 2011;111:353e7. Search in Google Scholar

46 Alkhalil M, Schulman ES, Getsy J. Obstructive sleep apnea syndrome and asthma: the role of continuous favorable airway pressure treatment. AnnAllergy Asthma Immunol 2008;101:350e7. Search in Google Scholar

47 Devouassoux G, Levy P, Rossini E, Pin I, Fior-Gozlan M, Henry M, et al. Sleep apnea is associated with bronchial inflammation and continuous positive airway pressure-induced hyperresponsiveness. J Allergy Clin Immunol 2007;119:597e603. Search in Google Scholar

48 Korczynski P, Gorska K, Przybylowski T, Bielicki P, Zielinski J, Chazan R. Continuous favorable airway pressure treatment increases bronchial reactivity in obstructive sleep apnea patients. Respiration 2009;78:404e10. Search in Google Scholar

49 Martin RJ, Pak J. Nasal CPAP in nonapneic nocturnal asthma. Chest1991;100:1024e7. Search in Google Scholar

50 Simard B, Turcotte H, Marceau P, Biron S, Hould FS, Lebel S, et al. Asthma and sleep apnea in patients with morbid obesity: outcome after bariatric surgery. Obes Surg 2004;14:1381e8. Search in Google Scholar

51 Bharati Prasad, Sharmilee M. Nyenhuis a, Terri E. Weaver B.M. (2013) Obstructive sleep apnea and asthma: Associations and treatment implications. Division of Pulmonary, Critical Care, Sleep, and Allergy, College of Medicine, University of Illinois at Chicago, USA. Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, US. Search in Google Scholar

52 Shen T.-C., Lin C.-L., Wei C.-C., Chen C.-H., Tu C.-Y., Hsia T.-C., Shih C.-M., Hsu W.-H., Sung F.-C., Kao C.-H. Risk of Obstructive Sleep Apnea in Adult Patients with Asthma: A Population-Based Cohort Study in Taiwan. PLoS ONE. 2015;10:e0128461. doi: 10.1371/journal.pone.0128461. [PMC free article] [PubMed] [CrossRef] [Google Scholar] Search in Google Scholar

53 Damini Saxena, Ikuyo Imayama, and Muhammad Adrish Miguel Angel Martinez-Garcia, J Clin Med. 2023 Oct; 12(20): 6552. They were published online on 2023 Oct 16. doi: 10.3390/jcm12206552 Academic Editor. Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs Search in Google Scholar

54 Santos C.B., Hanks C., McCann J., Lehman E.B., Pratt E., Craig T.J. The Role of Montelukast on Perennial Allergic Rhinitis and Associated Sleep Disturbances and Daytime Somnolence. Allergy Asthma Proc. 2008;29:140–145. doi: 10.2500/aap.2008.29.3097. [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

55 Adrish M., Hanania N.A. I am choosing Switching Biological Agents for Severe Asthma. Respirology. 2022;27:926–928. doi: 10.1111/resp.14377. [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

56 Bergmann K.-C., Zuberbier T. Obstructive Sleep Apnoe Improves on Dupilumab in Patients Treated for Polyposis and Severe Asthma. Eur. Respir. J. 2021;58:PA752. Doi: 10.1183/13993003. CONGRESS-2021.PA752. [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

57 Scioscia G., Buonamico E., Foschino Barbaro M.P., Lacedonia D., Sabato R., Carpagnano G.E. Omalizumab as Add-on Therapy in a Patient with Severe Asthma and OSA. Respirol. Case Rep. 2020;8:e0518. doi: 10.1002/rcr2.518. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

58 Hancu A, Mihaltan F, Radulian G. Asthma and Ultra-Processed Food. Maedica. 2019;14(4):402–407. doi: 10.26574/maedica. 2019.14.4.402 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

59 Alwarith J, Kahleova H, Crosby L, et al. The role of nutrition in asthma prevention and treatment. Nutr Rev. 2020;78(11): 928–938. doi: 10.1093/nutrient/nuaa005 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

60 Park S, Akinbami LJ, McGuire LC, Blanck HM. Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013. Prev Med. 2016;91:58–61. doi: 10.1016/j. ypmed.2016.08.004 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

61 DeChristopher LR, Tucker KL. Excess free fructose, high-fructose corn syrup, and adult asthma: the Framingham Offspring Cohort. Br J Nutr. 2018;119(10):1157–1167. Doi: 10.1017/S0007114518000417 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

62 Saeed MA, Gribben KC, Alam M, Lyden ER, Hanson CK, LeVan TD. Association of Dietary Fiber on Asthma, Respiratory Symptoms, and Inflammation in the Adult National Health and Nutrition Examination Survey Population. Ann Am Thorac Soc. 2020;17(9):1062–1068. doi: 10.1513/AnnalsATS.201910-776OC [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

63 Hosseini B, Berthon BS, Wark P, Wood LG. Effects of Fruit and Vegetable Consumption on Risk of Asthma, Wheezing and Immune Responses: A Systematic Review and Meta-Analysis. Nutrients. 2017;9(4):E341. doi: 10.3390/nu9040341 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

64 Collins SÉ, Phillips DB, Brotto AR, Rampuri ZH, Stickland MK. Ventilatory efficiency in athletes, asthma and obesity. Eur Respir Rev Off J Eur Respir Soc. 2021;30(161):200206. doi: 10.1183/16000617.0206-2020 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

65 Hiles SA, Gibson PG, Agusti A, McDonald VM. Treatable Traits That Predict Health Status and Treatment Response in Airway Disease. J Allergy Clin Immunol Pract. 2021;9(3):1255–1264.e2. doi: 10.1016/j.jaip.2020.09.046 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

66 Adeniyi FB, Young T. Weight loss interventions for chronic asthma. Cochrane Database Syst Rev. 2012;(7): CD009339. Doi: 10.1002/14651858.CD009339.pub2 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

67 Özbey Ü, Balaban S, Sözener ZÇ, Uçar A, Mungan D, Mısırlıgil Z. The effects of diet-induced weight loss on asthma control and quality of life in obese adults with asthma: a randomized controlled trial. J Asthma Off J Assoc Care Asthma. 2020;57(6):618–626. doi: 10.1080/02770903.2019.1590594 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

68 Dixon AE, Pratley RE, Forgione PM, et al. Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. J Allergy Clin Immunol. 2011;128(3): 508–515.e1–2. doi: 10.1016/j.jaci.2011.06.009 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

69 van Huisstede A, Rudolphus A, Castro Cabezas M, et al. Effect of bariatric surgery on asthma control, lung function and bronchial and systemic inflammation in morbidly obese subjects with asthma. Thorax. 2015;70(7):659–667. doi: 10.1136/thoraxjnl-2014-206712 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

70 Menzies-Gow A, Corren J, Bourdin A, et al. Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma. N Engl J Med. 2021;384(19):1800–1809. doi: 10.1056/NEJMoa2034975 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

71 Foer D, Beeler PE, Cui J, Karlson EW, Bates DW, Cahill KN. Asthma Exacerbations in Patients with Type 2 Diabetes and Asthma on Glucagon-like Peptide-1 Receptor Agonists. Am J Respir Crit Care Med. 2021;203(7):831–840. doi: 10.1164/rccm.202004-0993OC [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

72 Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205–216. doi: 10.1056/NEJMoa2206038 [PubMed] [CrossRef] [Google Scholar] [Ref list] Search in Google Scholar

73 Hiles SA, Gibson PG, Agusti A, McDonald VM. Treatable Traits That Predict Health Status and Treatment Response in Airway Disease. J Allergy Clin Immunol Pract. 2021;9(3):1255–1264.e2. doi: 10.1016/j.jaip.2020.09.046 [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

74 Sunata K, Kabata H, Kuno T, et al. The effect of statins for asthma. A systematic review and meta-analysis. J Asthma Off J Assoc Care Asthma. 2022;59(4):801–810. doi: 10.1080/02770903.2021.1879850 [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

75 Holguin F, Grasemann H, Sharma S, et al. L-Citrulline increases nitric oxide and improves control in obese asthmatics. JCI Insight. 2019;4(24):131733. doi: 10.1172/jci.insight.131733 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

76 Lang JE, Mougey EB, Hossain MJ, et al. Fish Oil Supplementation in Overweight/Obese Patients with Uncontrolled Asthma. A Randomized Trial. Ann Am Thorac Soc. 2019;16(5):554–562. doi: 10.1513/AnnalsATS.201807-446OC [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar

77 Michalovich D, Rodriguez-Perez N, Smolinska S, et al. Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients. Nat Commun. 2019;10(1):5711. doi: 10.1038/s41467-019-13751-9 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]. Search in Google Scholar