A total diet replacement weight management programme for difficult-to-treat asthma associated with obesity: a randomised controlled feasibility trial

Sharma, V., Ricketts, H. C., McCombie, L., Brosnahan, N. , Crawford, L., Slaughter, L., Goodfellow, A., Lean, M. E.J. and Cowan, D. C. (2023) A total diet replacement weight management programme for difficult-to-treat asthma associated with obesity: a randomised controlled feasibility trial. Chest, 163(5), pp. 1026-1037. (doi: 10.1016/j.chest.2023.01.015) (PMID:36649753)

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Abstract

Background: Obesity is often associated with uncontrolled, difficult-to-treat asthma and increased morbidity and mortality. Previous studies suggest that weight loss may improve asthma outcomes but with heterogenous asthma populations studied and unclear consensus on optimal method of weight management. The Counterweight-Plus weight management programme (CWP) is an evidence-based, dietitian-led, total diet replacement (TDR) programme. Research question: Can use of the CWP compared to usual care (UC) improve asthma control and quality of life in patients with difficult-to-treat asthma and obesity? Study design and methods: We conducted a 1:1 (CWP:UC) randomised, controlled single centre trial in adults with difficult-to-treat asthma and body mass index ≥30kg/m2. CWP: 12-week TDR phase (800kcal/day low-energy formula); stepwise food reintroduction and weight loss maintenance up to 1 year. Primary outcome: change in asthma control questionnaire (ACQ6) score over 16 weeks. Secondary outcome: change in asthma quality of life questionnaire (AQLQ) score. Results: 35 participants were randomised (36 screened) and 33 attended 16-week follow-up (17 CWP, 16 UC). Overall, mean (95%CI) ACQ6 at baseline was 2.8 (2.4, 3.1). Weight loss was greater in CWP than UC (mean difference -12.1kg; 95%CI -16.9, -7.4; p<0.001). ACQ6 improved more in CWP than UC (mean difference -0.69; 95%CI -1.37, -0.01; p=0.048). A larger proportion of participants achieved minimal clinically important difference in ACQ6 with CWP than UC (53% vs 19%; p=0.041; NNT 3 (95%CI 1.5, 26.9)). AQLQ improvement was greater in CWP than UC (mean difference 0.76; 95%CI 0.18, 1.34; p=0.013). Interpretation: Utilising a structured weight management programme results in clinically important improvements in asthma control and quality of life over 16 weeks compared to usual care, in adults with difficult-to-treat asthma and obesity. This generalisable programme is easy to deliver for this challenging phenotype. Longer-term outcomes continue to be studied.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McCombie, Ms Louise and Brosnahan, Dr Naomi and Cowan, Douglas and Lean, Professor Michael and Slaughter, Ms Lesley and Ricketts, Clare and Sharma, Dr Varun and Crawford, Mrs Luisa
Authors: Sharma, V., Ricketts, H. C., McCombie, L., Brosnahan, N., Crawford, L., Slaughter, L., Goodfellow, A., Lean, M. E.J., and Cowan, D. C.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Chest
Publisher:Elsevier
ISSN:0012-3692
ISSN (Online):1931-3543
Published Online:14 January 2023
Copyright Holders:Copyright © 2023 Crown Copyright
First Published:First published in Chest 163(5): 1026-1037
Publisher Policy:Reproduced under a Creative Commons License

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