Imbalanced Coagulation in the Airway of Type-2 High Asthma with Comorbid Obesity

Abstract

Jack T Womble, Victoria L McQuade, Mark D Ihrie, Jennifer L Ingram Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC, 27710, USACorrespondence: Jennifer L IngramDivision of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Box 2641, DUMC Research Drive, Durham, NC, 27710, USATel [phone]Fax [phone]Email [email protected]: Asthma is a common, chronic airway inflammatory disease marked by airway hyperresponsiveness, inflammation, and remodeling. Asthma incidence has increased rapidly in the past few decades and recent multicenter analyses have revealed several unique asthma endotypes. Of these, type-2 high asthma with comorbid obesity presents a unique clinical challenge marked by increased resistance to standard therapies and exacerbated disease development. The extrinsic coagulation pathway plays a significant role in both type-2 high asthma and obesity. The type-2 high asthma airway is marked by increased procoagulant potential, which is readily activated following damage to airway tissue. In this review, we summarize the current understanding of the role the extrinsic coagulation pathway plays in the airway of type-2 high asthma with comorbid obesity. We propose that asthma control is worsened in obesity as a result of a systemic and local airway shift towards a procoagulant and anti-fibrinolytic environment. Lastly, we hypothesize bariatric surgery as a treatment for improved asthma management in type-2 high asthma with comorbid obesity, facilitated by normalization of systemic procoagulant and pro-inflammatory mediators. A better understanding of attenuated coagulation parameters in the airway following bariatric surgery will advance our knowledge of biomolecular pathways driving asthma pathobiology in patients with obesity.Keywords: asthma, obesity, coagulation, bariatric surgery, extrinsic pathway, inflammation

Keywords

• asthma
• obesity
• coagulation
• bariatric surgery
• extrinsic pathway
• inflammation