A 1-Year Weight Management Program for Difficult-to-Treat Asthma With Obesity: A Randomized Controlled Study.

Background: Obesity-associated asthma results in increased morbidity and mortality. We report 1-year asthma outcomes with a weight management regimen, the Counterweight-Plus Programme (CWP), compared with usual care (UC) in a single-center, randomized controlled trial in patients with difficult-to-treat asthma and obesity.
Research Question: Can use of the CWP result in improved asthma control and quality of life compared with UC at 1 year in patients with difficult-to-treat asthma and obesity?
Study Design and Methods: Adults with difficult-to-treat asthma and BMI ≥ 30 kg/m ² were randomized (1:1 CWP:UC) to treatment. The CWP, with dietitian support, included a 12-week total diet replacement phase (850 kcal/d low-energy formula), and then subsequent food reintroduction and maintenance phases up to 1 year. Outcomes include results of the six-item Asthma Control Questionnaire (ACQ-6) and Asthma Quality of Life Questionnaire (AQLQ), as well as health care usage. A minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.
Results: Of 36 patients recruited, 29 attended visits at 52 weeks (13 CWP and 16 UC). The CWP resulted in greater weight change (median, -14 kg [interquartile range (IQR), -15 to -9 kg]) compared with UC (median, 2 kg [IQR, -7 to 8 kg]; P = .015) at 52 weeks. A greater proportion achieved MCID with the CWP vs UC in AQLQ (71% vs 6%, respectively; P < .001). No between-group differences were observed in ACQ-6. Median exacerbation frequency was reduced over 52 weeks with the CWP from 4 (IQR, 2 to 5) to 0 (IQR, 0 to 2) (P < .001), although no between-group difference was observed. Seventy percent of the CWP group lost ≥ 10% body weight and had improvement in ACQ-6 (mean difference, -1.1; 95% CI, -1.9 to -0.3; P = .018) and AQLQ (mean difference, 1.2; 95% CI, 0.4, 2.1; P = .011) across 52 weeks.
Interpretation: In this study, the use of a dietitian-supported weight management program resulted in sustained weight loss and is a potential treatment for obesity in asthma. The CWP resulted in a higher proportion achieving MCID improvements in AQLQ compared with UC. Within-group differences in AQLQ and exacerbation frequency suggest potential with the CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.
Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: V. S. and H. C. R. have received travel awards to attend conferences. V. S. has received fees for presentations from AstraZeneca. N. B. has received funding from Cambridge Weight Plan for PhD program and conference and travel expenses and has shares in and is an employee of Counterweight Ltd. R. C. has received funding from AstraZeneca for a study within a Medical Research Council project as investigator lead; has received payment for lectures from GSK, AstraZeneca, Teva, Chiesi, Sanofi, and Novartis; has received funding to attend conferences from Chiesi, Sanofi, and GSK; and has participated on advisory board meetings for GSK, AstraZeneca, Teva, Chiesi, and Novartis. M. E. J. L. has received grants from the National Institute for Health and Care Research, Diabetes UK, All Saints Educational Trust, Novo Nordisk, and MJ Smith Trust for the study; has received consulting fees from Novo Nordisk and Nestle; has received payment for lectures from Oviva, Merck, Sanofi, and Roche; and is a medical advisor for Counterweight Ltd. None declared (L. M., L. C., L. S., A. G., F. S., D. C. C.).
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)