Fernando Holguin, MD, explains why increased risk of pulmonary disease may be overlooked when assessing obesity risk factors.
I hope the COVID-19 pandemic and its impact on obese individuals will help spur more research on the interaction between metabolic syndrome and pulmonary disease, said Fernando Holguin, MD, a pulmonologist and critical care doctor at the University of Colorado Anschutz Medical Campus.
When increased rates of obesity and associated conditions are discussed, pulmonary diseases often are not included in this dialogue. Why do you think this is?
I think there's certainly been a lag in medical knowledge that metabolic factors impair lung function. There's an incredible wealth of information that shows, that, indeed metabolic syndrome and obesity are risk factors for vascular dysfunction. But our research, as well as research from others, has shown that in many of these patients, these metabolic dysregulations can actually cause what we coin as airway dysfunction, the inability of the airways bronchodilate normally through a variety of different mechanisms. I don't think it's widely recognized, but it certainly is a significant problem.
If you look at, for example, an incidence of an odds ratio or risk ratio of 1.4 to 2—so either 50%, or even doubling the rates of asthma associated with obesity and with metabolic syndrome—and considering that 30% to 40% of the US population is obese now, particularly in some minority groups, clearly, this poses a huge risk for new cases of asthma and those with asthma to have worsening disease. In my view, this is a very significant link or problem.
The real concern is that many of these patients live in this nonallergic spectrum of asthma, so these noneosinophilic states, particularly those who have late-onset disease. Their response to inhaled corticosteroids and some of the drugs that we have to treat patients with predominantly eosinophilic inflammation are just not there.
There's really good new research coming into biologicals that work on a different space and some other metabolic pathways and those that influence mitochondrial function in the airways, which is another area that seems to be impaired in patients with metabolic syndrome. I think there's a lot of new stuff coming out that could potentially improve the health of these patients. But currently, there is just not a lot to do for them, aside from losing weight and improving their metabolic profiling.
Do you think the COVID-19 pandemic and its effect on overweight and obese individuals will help spur more research on the relationship between metabolic syndrome and pulmonary disease?
I should hope so. You bring a very good point. Clearly, nobody thought that a virus would more severely affect people in their lungs that suffered from metabolic syndrome or obesity. I think that that clearly has shown that there's unique immune-metabolic interactions that render the individual more susceptible to other diseases.
Inflammation doesn't happen without changing metabolism, and vice versa. These things just happen together. It's just that our research, and by that I mean the people that fund us to do these research, want us to be so focused on one area, that it's somewhat risky to start to ping into other areas, which means we need to have a lot more crosstalk between researchers focusing on the metabolic space and the autoimmune inflammatory space, and really start to think out of the box or more creatively about how to solve some of these problems.