Obesity as a barrier to remission in severe asthma

Summaries 3 min 12

Font Size

Created On: 09/10/2026

Obesity is increasingly recognized as an important factor in severe asthma, with excess body weight associated with greater disease burden and poorer asthma control.

See All

Key take away

Biologic therapy improves severe asthma across BMI categories, but patients with morbid obesity continue to have poorer clinical outcomes.

Background

Obesity is increasingly recognized as an important factor in severe asthma, with excess body weight associated with greater disease burden and poorer asthma control. With biologic therapies becoming an important part of severe asthma management, clinical remission (CR) has emerged as an important treatment goal. However, the influence of obesity on treatment response and remission remains clinically relevant.

Researchers conducted a prospective observational study to determine the prevalence of overweight and obesity and assess their influence on biologic treatment outcomes and CR in patients with severe asthma.

Method

This study included 525 patients with severe asthma recruited in the Kuwait Severe Asthma Registry (KSAR). Patients were categorized as normal weight, overweight, mildly to moderately obese, or morbidly obese according to body mass index (BMI). Demographic, clinical, lung function, and biomarker data were collected. Biomarkers encompassed fractional exhaled nitric oxide (FeNO), blood eosinophil count (BEC), and total immunoglobulin E (IgE), while interleukin- 4 (IL-4) and interleukin- 6 (IL-6) gene polymorphisms were also assessed.

Subjects who received biologic therapy for at least 12 months were followed for treatment outcomes. Patients were classified as being in clinical remission when they experienced no exacerbations, required no oral corticosteroid (OCS) therapy, and met the following thresholds: asthma control test (ACT) ≥20, asthma control questionnaire (ACQ-6) ≤0.75, and predicted forced expiratory volume in one second (FEV1) ≥80%.

Result

The analysis showed a high prevalence of obesity and poorer clinical outcomes among patients with severe asthma, particularly those with morbid obesity.

15.4% of patients had normal weight, indicating a high prevalence of overweight and obesity.
Morbid obesity was linked with poorer asthma control, lower lung function, and more frequent diabetes, allergic rhinitis, exacerbations, and OCS use.
Biologic therapy led to improvements in asthma control, exacerbations, OCS use, and lung function across all BMI groups.
Despite treatment, patients with morbid obesity continued to have poorer asthma control and lung function with higher exacerbation and OCS rates.
CR was achieved in 17.3% of patients, with rates of 25% in normal-weight and 11% in morbidly obese patients.
Younger age and IL-4 CC genotype were linked with a higher likelihood of remission, whereas BEC, total IgE, and FeNO illustrated no significant changes.

Conclusion

Biologic therapy improved key clinical outcomes across BMI groups, but morbid obesity remained associated with poorer asthma control and a lower likelihood of CR. The findings highlighted the importance of considering weight management alongside personalized biologic treatment when managing severe asthma.