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Objective There is a high prevalence of obesity in people with asthma, and obesity is associated with poorly controlled asthma. Significant weight loss might improve asthma control: the purpose of this study was to investigate patient characteristics and factors that might affect implementation of a weight loss and/or roflumilast intervention, to target both obesity and asthma. Methods A cross‐sectional study of people with obesity and poorly controlled asthma performed at 13 sites across the United States. Results One hundred and two people participated in this study. Median BMI was 37 (IQR 35–42). The majority, 55%, were African American and 76% were female. Fifty two percent had very poorly controlled asthma. Most participants were quite sedentary (70% reported being inactive or participating only in light‐intensity activities according to the Stanford Brief Activity Survey). Participants reported significant impairments related to physical function on the Impact of Weight on Quality of Life‐Lite questionnaire (median score 67 [IQR 41–84]). Thirty‐five percent of participants reported mild, and 2 % moderate, depressive symptoms as assessed by the Patient Health Questionnaire‐9. Conclusions Poorly controlled asthma and obesity often affect minority populations and are associated with significant impairments in health related to physical function and low levels of physical activity that might complicate efforts to lose weight. Interventions targeted at poorly controlled asthma associated with obesity in the United States need to address factors complicating health in underserved communities, such as increasing opportunities for physical activity, while also managing activity limitations related to the combination of asthma and obesity.

People with obesity often have severe, difficult to control asthma. There is a need to develop better treatments in this population. One potential treatment is roflumilast, a phosphodiesterase 4 inhibitor, as it is reported to have efficacy for treatment of asthma and can promote weight loss.to investigate the potential efficacy of roflumilast for the treatment of poorly controlled asthma in people with obesity.A randomized, double-masked, placebo-controlled trial of 24 weeks of roflumilast versus placebo for the treatment of poorly controlled asthma in people with obesity (body mass index ≥ 30 kg/m2). The primary outcome was change in asthma control test score (ACT).Twenty-two people were randomized to roflumilast, 16 to placebo. Roflumilast had no effect on change in ACT (increased by 2.6 [IQR 0.5 to 4.4] in those on roflumilast versus 2.0 [IQR 0.7 to 3.3] in those on placebo). Participants assigned to roflumilast had a 3.5 fold (Relative risk [RR] 95% confidence interval [CI] 1.3 to 9.4) increased risk of an episode of poor asthma control and an 8.1-fold (RR 95% CI 1.01 to 65.0) increased risk of an urgent care visit for asthma. Ten participants (56%) assigned to roflumilast required a course of oral corticosteroids for asthma exacerbations and none in the placebo group. Participants losing ≥ 5% of their body weight experienced a clinically and statistically significant improvement in asthma control (ACT increased by 4.4 [IQR 2.5, 6.3] versus 1.5 [IQR 0.0, 3.0] in those who lost5%).Roflumilast had no effect on asthma control. Of concern, roflumilast was associated with an increased risk of exacerbation in in obese individuals with poorly controlled asthma. These results highlight the importance of studying interventions in different sub-populations of people with asthma, particularly people with obesity and asthma who may respond differently to medications than lean people with asthma. Weight loss of at least 5% was associated with improved asthma control indicating that interventions- other than roflumilast -promoting weight loss may have efficacy for treatment of poorly controlled asthma in people with obesity.

BACKGROUND: Weight loss might improve asthma control in people with obesity. However, people with asthma might have particular challenges losing weight and the amount of weight loss needed to improve asthma control is not clear. OBJECTIVES: To pilot test an online weight loss intervention and to estimate the impact of weight loss on asthma control. METHODS: We performed a 6-month, single-arm, futility trial of an online weight loss intervention at two centers. To reject the assumption of futility, 9 or more participants had to lose at least 5% of their body weight. We also assessed the association between weight loss (5% or more) and asthma outcomes. RESULTS: Forty-three participants (85% women) started the weight loss intervention; median and interquartile range (IQR) for BMI was 40.3 kg/m(2) (34.7, 46.8), and 14 (12, 17) for Asthma Control Test score. At 6 months, 10 participants (23%, 95%CI 12%, 39%) lost at least 5% of their initial weight. Weight loss of at least 5% was associated with a clinically and statistically significant improvements in their Asthma Control Test (median [IQR] increase of 3 [1 7], p< 0.05), Marks Asthma Quality of Life Score (−9.5 [ −18, −3], p=0.008), and their general health-related quality of life score (RAND-36) improved by 9.4 [ 2.8, 22.5], p=0.014). CONCLUSION: An online weight loss intervention has potential to meet FDA guidance for product evaluation (at least 5% weight loss in 35% of people) for obesity, and is associated with a clinically significant improvement in asthma control, quality of life, and overall health-related quality of life.