The US epidemic of obesity is now a global epidemic and the number of obese patients that are diagnosed with asthma is increasing at an alarming rate. Moreover, obese patients are more diffi cult to manage, have worse lung function, and have asthma symptoms that are less responsive to pulmonary medications. Specifi c strategies are needed for this group of patients. The undoubted and obvious treatment is weight loss since weight loss not only reduces asthma symptoms but improves lung function and reduces exacerbation rates.
Additionally, weight loss reduces cardiovascular risks and diabetes. Bariatric surgery, along with dietary restrictions, is the most effective method to achieve weight loss. 20% to 30% of body weight can be lost within 2 to 3 years. However, surgery may not be available for some patients that do not meet the weight criteria for surgery, or who are a greater surgical risk because of their lung disease. Alternative non-surgical strategies need to be considered for many obese patients with asthma. It should come as no surprise that dietary restriction needs to be an important part of the strategy, but the use of exercise has been found to have more benefi t than just burning calories. Exercise has been found to reduce systemic and airway infl ammation and specifi cally eosinophilic infl ammation (often specifi c for asthma). Even if the weight loss in non-surgical patients is only 5% to 7%, the addition of exercise can make a signifi cant difference in the ability to control asthma symptoms in overweight patients.