The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which many pulmonary diseases’ pathophysiology is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions are independently related to asthma. Novel insights have also recently been brought by metabolomics in this field. The purpose of this review is to discuss current perspectives regarding metabolic dysfunction in asthma, from obesity-related asthma to other metabolic conditions, and the role of current pharmacological therapeutic strategies and lifestyle interventions.

Obesity is a well-recognized risk factor for asthma across the lifespan, generally associated with poorer response to currently available treatments, rendering a more severe, refractory disease status. Besides the epidemiological and clinical link, untargeted metabolomics studies have recently supported the molecular level’s obesity-associated asthma phenotype. Not only obesity-related but also other aspects of metabolic dysregulation can be independently linked to asthma. These include hyperinsulinemia, dyslipidemia, and hypertension, which need to be considered, even in the non-obese patient. Untargeted metabolomics studies have further highlighted several other metabolic pathways that can be altered in asthma, namely regarding oxidative stress and systemic inflammation, and suggest the importance of microbiota in asthma pathogenesis. Considering the reduced response to corticosteroids, other pharmacologic treatments are useful regardless of body mass index. Non-pharmacologic treatments (namely, weight reduction and dietary changes) may substantially benefit the asthmatic patient. Taken together, this evidence points towards the need to improve our knowledge in this field and, in particular, to address the influence of environmental factors in metabolic dysfunction and asthma development.

Personalized medicine is needed to optimize treatment, including a holistic view of the asthmatic patient to set accurate pharmacologic therapy and dietary, physical exercise, and lifestyle interventions.