Abstract: 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


中文翻译：

---

合并肥胖的 2 型重度哮喘气道凝血不平衡

【摘要】：哮喘是一种常见的慢性气道炎症性疾病,以气道高反应性、炎症和重塑为特征。过去几十年来，哮喘发病率迅速增加，最近的多中心分析揭示了几种独特的哮喘内型。其中，伴有肥胖症的 2 型高位哮喘提出了独特的临床挑战，其特点是对标准疗法的抵抗力增加和疾病发展加剧。外源性凝血途径在2型高哮喘和肥胖症中均发挥着重要作用。2 型高哮喘气道的特点是促凝血潜力增加，在气道组织受损后很容易被激活。在这篇综述中，我们总结了目前对外源性凝血途径在合并肥胖的 2 型高哮喘气道中所起作用的认识。我们认为，肥胖患者的哮喘控制恶化是由于全身和局部气道向促凝血和抗纤溶环境转变的结果。最后，我们假设减肥手术可作为改善 2 型高位哮喘伴肥胖症管理的治疗方法，通过全身促凝血和促炎介质的正常化来促进。更好地了解减肥手术后气道中减弱的凝血参数将增进我们对肥胖患者哮喘病理学驱动的生物分子途径的了解。

关键词：哮喘、肥胖、凝血、减肥手术、外源性途径、炎症