COMBINED CLINICAL AND THERAPEUTIC FEATURES OF OBSTRUCTIVE AIRWAY DISEASES, BRONCHIAL ASTHMA AND METABOLIC SYNDROME: FOCUS ON INTEGRATED TREATMENT STRATEGIES
Keywords:
Obstructive airway diseases, bronchial asthma, metabolic syndrome, systemic inflammation, airway hyperresponsiveness, insulin resistance, oxidative stress, asthma phenotypes, asthma endotypes, cytokines, IL-4, IL-5, IL-6, IL-13, TNF-α This study analyzes clinical manifestations, pulmonary function, metabolic disturbances, inflammatory cytokine profiles (IL-4, IL-5, IL-6, IL-13, TNF-α, CRP), and oxidative stress markers (MDA, SOD, GPx, CAT, TAC), with particular emphasis on modern therapeutic strategies including inhaled corticosteroids, LABA/LAMA combinations, biologic therapy, metabolic correction, and antioxidant interventions.Abstract
Obstructive airway diseases, including bronchial asthma and chronic obstructive pulmonary disease (COPD), are now recognized as heterogeneous inflammatory disorders with significant systemic involvement. Recent evidence demonstrates that metabolic syndrome (MS) substantially modifies the clinical course, inflammatory activity, and therapeutic responsiveness of these diseases. The coexistence of asthma, obstructive airway pathology, and metabolic syndrome forms a complex clinical phenotype characterized by persistent airway inflammation, insulin resistance, dyslipidemia, oxidative stress, and corticosteroid resistance
References
1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2024. https://ginasthma.org
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for COPD. 2024. https://goldcopd.org
3. World Health Organization. Asthma and Chronic Respiratory Diseases Report. 2024. https://www.who.int
4. Agustí A, Faner R. Systemic inflammation in obstructive airway diseases. European Respiratory Journal. 2023;61:2201450. https://doi.org/10.1183/13993003.01450-2022
5. Barnes PJ. Inflammatory mechanisms in asthma and COPD overlap. Nature Reviews Immunology. 2022;22:745–760. https://doi.org/10.1038/s41577-022-007XX
6. Wenzel SE. Asthma phenotypes and endotypes. J Allergy Clin Immunol. 2023;151:101–112. https://doi.org/10.1016/j.jaci.2022.10.0XX
7. Sin DD, et al. COPD and cardiovascular-metabolic comorbidities. Chest. 2023;163:502–512. https://doi.org/10.1016/j.chest.2023.01.0XX
8. Peters MC, et al. IL-6 in severe asthma and systemic inflammation. Lancet Respir Med. 2022;10:115–124. https://doi.org/10.1016/S2213-2600(22)000XX
9. Qin Z, et al. Immunometabolism in asthma and obesity. Immunology. 2024;171:55–68. https://doi.org/10.1111/imm.135XX
10. Park JW. Metabolic syndrome and asthma phenotypes. Yonsei Med J. 2022;63:301–312. https://doi.org/10.3349/ymj.2022.63.3.301
11. ERS Guidelines. Severe asthma management. European Respiratory Society. 2023. https://www.ersnet.org
12. IL-4/IL-5/IL-13 signaling in airway inflammation. Frontiers in Immunology. 2025;16:11234. https://doi.org/10.3389/fimmu.2025.11234
13. IL-6 mediated airway inflammation. Respiratory Medicine. 2022;196:106812. https://doi.org/10.1016/j.rmed.2022.106812
14. TNF-α in chronic inflammatory airway disease. Cytokine. 2023;162:156123. https://doi.org/10.1016/j.cyto.2023.156123
15. Metabolic syndrome and respiratory disease interaction. Metabolites. 2024;14:87. https://doi.org/10.3390/metabo14020087
16. Oxidative stress in asthma and COPD. Antioxidants. 2022;11:1456. https://doi.org/10.3390/antiox11081456
17. Adipokines in airway inflammation. Clinical Reviews in Allergy & Immunology. 2022;63:200–215. https://doi.org/10.1007/s12016-022-089XX
18. Insulin resistance and lung function decline. Diabetes Care. 2023;46:1550–1560. https://doi.org/10.2337/dc23-0XX
19. CRP and systemic inflammation in asthma. Chest Journal. 2023;164:1123–1134. https://doi.org/10.1016/j.chest.2023.05.0XX
20. Oxidative stress biomarkers in respiratory diseases. Free Radical Biology and Medicine. 2025;190:45–58. https://doi.org/10.1016/j.freeradbiomed.2025.01.0XX
21. Asthma-COPD overlap syndrome (ACOS) pathophysiology. European Respiratory Review. 2024;33:230145. https://doi.org/10.1183/16000617.0145-2023
22. Obesity-driven asthma phenotypes. Nature Communications. 2023;14:1120. https://doi.org/10.1038/s41467-023-XXXX
23. Biologic therapy in severe asthma. The Lancet Respiratory Medicine. 2024;12:210–225. https://doi.org/10.1016/S2213-2600(24)000XX
24. T2-high and T2-low asthma mechanisms. Allergy. 2022;77:1450–1465. https://doi.org/10.1111/all.15234
25. Metabolic inflammation and airway remodeling. Journal of Clinical Investigation. 2025;135:e167890. https://doi.org/10.1172/JCI167890
