Abstract
Obesity causes significant changes in lung function, many of which are secondary to the reduction in operating lung volume caused by a stiffening of the respiratory system. In addition, reductions in the volume of the intrathoracic cavity, due to the presence of adipose tissue and changes in other structures, may also contribute to an overall reduction in lung volume. Thus, the primary effects of obesity on lung function arise from the mechanical effects of adipose tissue on the respiratory system. However, some studies have reported changes in airway function associated with obesity that appear to be independent of lung volumes, though the causes of these abnormalities are unknown. It is unclear whether the mechanical effects of obesity on lung function can increase the risk of respiratory symptoms in otherwise healthy individuals. However, in respiratory disease, a reduction in operating lung volume may increase symptoms during bronchoconstriction in asthma and protect against symptoms during exercise in COPD.
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Watson RA, Pride NB, Thomas EL, et al. Reduction of total lung capacity in obese men: comparison of total intrathoracic and gas volumes. J Appl Physiol. 2010;108:1605–12.
Behazin N, Jones SB, Cohen RI, Loring SH. Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol. 2010;108:212–8.
Sugerman H, Windsor A, Bessos M, Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med. 1997;241:71–9.
Sutherland TJT, Goulding A, Grant AM, et al. The effect of adiposity measured by dual-energy x-ray absorptiometry on lung function. Eur Respir J. 2008;32:85–91.
Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.
Sharp JT, Henry JP, Swaeny SK, Meadows WR, Pietras RJ. The total work of breathing in normal and obese men. J Clin Invest. 1964;43:728–39.
Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87:654–60.
Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20:248–54.
Suratt PM, Wilhoit SC, Hsiao HS, Atkinson RL, Rochester DF. Compliance of chest wall in obese subjects. J Appl Physiol. 1984;57:403–7.
Steier J, Jolley CJ, Seymour J, et al. Neural respiratory drive in obesity. Thorax. 2009;64: 719–25.
Douglas FG, Chong PY. Influence of obesity on peripheral airways patency. J Appl Physiol. 1972;33:559–63.
Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109:144–51.
Rochester DF, Enson Y. Current concepts in the pathogenesis of the obesity hypoventilation syndrome. Mechanical and circulatory factors. Am J Med. 1974;57:402–20.
Sharp JT, Henry JP, Swaeny SK, Meadows WR, Pietras RJ. Effects of mass loading the respiratory system in man. J Appl Physiol. 1964;19:959–66.
Axen K, Haas SS, Haas F, Gaudino D, Haas A. Ventilatory adjustments during sustained mechanical loading in conscious humans. J Appl Physiol. 1983;55:1211–8.
Sampson MG, Grassino AE. Load compensation in obese patients during quiet tidal breathing. J Appl Physiol. 1983;55:1269–76.
Dempsey JA, Reddan W, Rankin J, Balke B. Alveolar-arterial gas exchange during muscular work in obesity. J Appl Physiol. 1966;21:1807–14.
Ofir D, Laveneziana P, Webb KA, O’Donnell DE. Ventilatory and perceptual responses to cycle exercise in obese women. J Appl Physiol. 2007;102:2217–26.
Mansell AL, Walders N, Wamboldt MZ, et al. Effect of body mass index on response to methacholine bronchial provocation in healthy and asthmatic adolescents. Pediatr Pulmonol. 2006;41:434–40.
Boulet L-P, Turcotte H, Boulet G, Simard B, Robichaud P. Deep inspiration avoidance and airway response to methacholine: influence of body mass index. Can Respir J. 2005;12: 371–6.
Salome CM, Munoz PA, Berend N, et al. Effect of obesity on breathlessness and airway responsiveness to methacholine in non-asthmatic subjects. Int J Obes. 2008;32:502–9.
Torchio R, Gobbi A, Gulotta C, et al. Mechanical effects of obesity on airway responsiveness in otherwise healthy humans. J Appl Physiol. 2009;107:408–16.
Jones RL, Nzekwu M-MU. The effects of body mass index on lung volumes. Chest. 2006;130:827–33.
King GG, Brown NJ, Diba C, et al. The effects of body weight on airway calibre. Eur Respir J. 2005;25:896–901.
Sin DD, Sutherland ER. Obesity and the lung: 4. Obesity and asthma. Thorax. 2008;63:1018–23.
Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN. The effect of body fat distribution on pulmonary function tests. Chest. 1995;107:1298–302.
Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128:501–6.
Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol. 2005;98:512–7.
Biring M, Lewis M, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293–7.
Zerah F, Harf A, Perlemuter L, et al. Effects of obesity on respiratory resistance. Chest. 1993;103:1470–6.
Chen Y, Rennie D, Cormier YF, Dosman JA. Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects. Am J Clin Nutr. 2007;85:35–9.
Canoy D, Luben R, Welch A, et al. Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, United Kingdom. Am J Epidemiol. 2004;159:1140–9.
Ochs-Balcom HM, Grant BJ, Muti P, et al. Pulmonary function and abdominal obesity in the general population. Chest. 2006;129:853–62.
Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function. Chest. 1997;111:891–8.
De Lorenzo A, Maiolo C, Mohamed EI, et al. Body composition analysis and changes in airways function in obese adults after hypocaloric diet. Chest. 2001;119:1409–15.
Babb TG, Wyrick BL, Chase PJ, et al. Weight loss via diet and exercise improves exercise breathing mechanics in obese men. Chest. 2011;140:454–60.
Yap JC, Watson RA, Gilbey S, Pride NB. Effects of posture on respiratory mechanics in obesity. J Appl Physiol. 1995;79:1199–205.
Rubinstein I, Zamel N, DuBarry L, Hoffstein V. Airflow limitation in morbidly obese, nonsmoking men. Ann Int Med. 1990;112:828–32.
Nicolacakis K, Skowronski ME, Coreno AJ, et al. Observations on the physiological interactions between obesity and asthma. J Appl Physiol. 2008;105:1533–41.
Pankow W, Podszus T, Gutheil T, et al. Expiratory flow limitation and intrinsic positive end-expiratory pressure in obesity. J Appl Physiol. 1998;85:1236–43.
Ferretti A, Giampiccolo P, Cavalli A, Milic-Emili J, Tantucci C. Expiratory flow limitation and orthopnea in massively obese subjects. Chest. 2001;119:1401–8.
Dellaca RL, Santus P, Aliverti A, et al. Detection of expiratory flow limitation in COPD using the forced oscillation technique. Eur Respir J. 2004;23:232–40.
Hedenstierna G, Santesson J, Norlander O. Airway closure and distribution of inspired gas in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20:334–42.
Hakala K, Mustajoki P, Aittomaki J, Sovijarvi AR. Effect of weight loss and body position on pulmonary function and gas exchange abnormalities in morbid obesity. Int J Obes. 1995;19:343–6.
Milic-Emili J, Torchio R, D’Angelo E. Closing-volume: a reappraisal (1967–2007). Eur J Appl Physiol. 2007;99:567–83.
Farebrother MJB, McHardy GJR, Munro JF. Relation between pulmonary gas exchange and closing volume before and after substantial weight loss in obese subjects. Br Med J. 1974;3: 391–3.
Holley HS, Milic-Emili J, Becklake MR, Bates DV. Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest. 1967;46:475–81.
Hurewitz A, Susskind H, Harold W. Obesity alters regional ventilation in lateral decubitus position. J Appl Physiol. 1985;59:774–83.
Demedts M. Regional distribution of lung volumes and of gas inspired at residual volume: influence of age, body weight and posture. Bull Eur Physiopathol Respir. 1980;16:271–85.
Jenkins SC, Moxham J. The effects of mild obesity on lung function. Respir Med. 1991;85: 309–11.
Thomas PS, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44:382–6.
Zavorsky GS, Murias JM, Kim DJ, et al. Waist-to-hip ratio is associated with pulmonary gas exchange in the morbidly obese. Chest. 2007;131:362–7.
Sutherland TJT, Cowan JO, Young S, et al. The association between obesity and asthma: interactions between systemic and airway inflammation. Am J Respir Crit Care Med. 2008;178:469–75.
Refsum HE, Holter PH, Lovig T, Stadaas JO. Pulmonary function and energy expenditure after marked weight loss in obese women: observations before and one year after gastric banding. Int J Obes. 1990;14:175–83.
Womack CJ, Harris DL, Katzel LI, et al. Weight loss, not aerobic exercise, improves pulmonary function in older obese men. J Gerontol A Biol Sci Med Sci. 2000;55:M453–7.
Chen Y, Horne SL, Dosman JA. Body weight and weight gain related to pulmonary function decline in adults: a six year follow up study. Thorax. 1993;48:375–80.
Sargent EN, Boswell Jr WD, Ralls PW, Markovitz A. Subpleural fat pads in patients exposed to asbestos: distinction from non-calcified pleural plaques. Radiology. 1984;152:273–7.
Kelly TM, Jensen RL, Elliott CG, Crapo RO. Maximum respiratory pressures in morbidly obese subjects. Respiration. 1988;54:73–7.
Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med. 2002;162:1477–81.
Schachter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001;56:4–8.
Schachter LM, Peat JK, Salome CM. Asthma and atopy in overweight children. Thorax. 2003;58:1031–5.
Leone N, Courbon D, Thomas F, et al. Lung function and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Crit Care Med. 2008;179:509–16.
Wise RA, Enright PL, Connett JE, et al. Effect of weight gain on pulmonary function after smoking cessation in the Lung Health Study. Am J Resp Crit Care Med. 1998;157:866–72.
Santamaria F, Montella S, Greco L, et al. Obesity duration is associated to pulmonary function impairment in obese subjects. Obesity (Silver Spring). 2011;19:1623–8.
Inselman LS, Spencer H. Obesity-induced hyperplastic lung growth. Am Rev Respir Dis. 1987;135:613–6.
Inselman LS, Chander A, Spitzer AR. Diminished lung compliance and elevated surfactant lipids and proteins in nutritionally obese young rats. Lung. 2004;182:101–17.
Sahebjami H. Dyspnea in obese healthy men. Chest. 1998;114:1373–7.
Collett F, Mallart A, Bervar JF, et al. Physiologic correlates of dyspnea in patients with morbid obesity. Int J Obes. 2007;31:700–6.
Larsson UE, Reynisdottir S. The six-minute walk test in outpatients with obesity: reproducibility and known group validity. Physiother Res Int. 2008;13:84–93.
Beriault K, Carpentier AC, Gagnon C, et al. Reproducibility of the 6-minute walk test in obese adults. Int J Sports Med. 2009;30:725–7.
Morinder G, Mattsson E, Sollander C, Marcus C, Larsson UE. Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiother Res Int. 2009;14:91–104.
Babb TG, Ranasinghe KG, Comeau LA, Semon TL, Schwartz B. Dyspnea on exertion in obese women. Association with increased oxygen cost of breathing. Am J Respir Crit Care Med. 2008;178:116–23.
Kress JP, Pohlman AS, Alverdy J, Hall JB. The impact of morbid obesity on oxygen cost of breathing (VO2RESP) at rest. Am J Respir Crit Care Med. 1999;160:883–6.
Babb TG, DeLorey DS, Wyrick BL, Gardner PP. Mild obesity does not limit change in end-expiratory lung volume during cycling in young women. J Appl Physiol. 2002;92: 2483–90.
Babb TG, Buskirk ER, Hodgson JL. Exercise end-expiratory lung volumes in lean and moderately obese women. Int J Obes. 1989;13:11–9.
DeLorey DS, Wyrick BL, Babb TG. Mild-to-moderate obesity: implications for respiratory mechanics at rest and during exercise in young men. Int J Obes. 2005;29:1039–47.
Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175:661–6.
Mosen DM, Schatz M, Magid DJ, Camargo Jr CA. The relationship between obesity and asthma severity and control in adults. J Allergy Clin Immunol. 2008;122:507–11. e6.
Vortmann M, Eisner MD. BMI and health status among adults with asthma. Obesity (Silver Spring). 2008;16:146–52.
Raviv S, Dixon AE, Kalhan R, Shade D, Smith LJ. Effect of obesity on asthma phenotype is dependent upon asthma severity. J Asthma. 2011;48:98–104.
Farah CS, Kermode JA, Downie SR, et al. Obesity is a determinant of asthma control, independent of inflammation and lung mechanics. Chest. 2011;140:659–66.
Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160:1856–61.
Fredberg J, Inouye D, Mijailovich M, Butler J. Perturbed equilibrium of myosin binding in airway smooth muscle and its implications in bronchospasm. Am J Resp Crit Care Med. 1999;159:959–67.
Sutherland TJT, Cowan JO, Taylor DR. Dynamic hyperinflation with bronchoconstriction: differences between obese and nonobese women with asthma. Am J Respir Crit Care Med. 2008;177:970–5.
van Veen IH, ten Brinke A, Sterk PJ, Rabe KF, Bel EH. Airway inflammation in obese and non-obese patients with difficult-to-treat asthma. Allergy. 2008;63:570–4.
Chinn S, Jarvis D, Burney P. Relation of bronchial responsiveness to body mass index in the ECRHS. Thorax. 2002;57:1028–33.
Chapman DG, Berend N, King GG, Salome CM. Increased airway closure is a determinant of airway hyperresponsiveness. Eur Respir J. 2008;32:1563–9.
Lougheed MD, Lam M, Forkert L, Webb KA, O’Donnell DE. Breathlessness during acute bronchoconstriction in asthma. Am Rev Respir Dis. 1993;148:1452–9.
Thomson CC, Clark S, Camargo Jr CA. Body mass index and asthma severity among adults presenting to the emergency department. Chest. 2003;124:795–802.
Guenette JA, Jensen D, O’Donnell DE. Respiratory function and the obesity paradox. Curr Opin Clin Nutr Metab Care. 2010;13:618–24.
Ora J, Laveneziana P, Wadell K, et al. Effect of obesity on respiratory mechanics during rest and exercise in COPD. J Appl Physiol. 2011;111:10–9.
Alakhras M, Decker PA, Nadrous HF, Collazo-Clavell M, Ryu JH. Body mass index and mortality in patients with idiopathic pulmonary fibrosis. Chest. 2007;131:1448–53.
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Salome, C.M., King, G.G., Berend, N. (2013). Effects of Obesity on Lung Function. In: Dixon, A., Clerisme-Beaty, E. (eds) Obesity and Lung Disease. Respiratory Medicine, vol 19. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-053-3_1
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