Original article 223
Assessment of serum levels of adiponectin and resistin in adult
patients with asthma: relation to obesity and disease severity
Salwa S. Hosnya, Mohamed N. Farresb, Nermine A. Melekb, Sylvia T. Kamalb,
Marwa R. El Najjarc, Radwa H. Abou El Fotohb, Asmaa M. Abd ElGwadd,
Amira R. Elmahdib
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Departments of aInternal Medicine,
Endocrinology, bInternal Medicine, Allergy and
Clinical Immunology, cClinical Pathology and
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Immunology, dMedical Biochemistry and
Molecular Biology, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
Correspondence to Amira R. Elmahdi, MD,
Department of Internal Medicine and Clinical
Immunology, Faculty of Medicine, Ain Shams
University, Abbassia, Cairo, 11566, Egypt.
Tel: +20 112 164 1520;
e-mail: dr_amiraramadan@yahoo.com
Received: 22 September 2020
Revised: 31 October 2020
Accepted: 13 January 2021
Published: 28 May 2021
The Egyptian Journal of Chest Diseases and
Tuberculosis 2021, 70:223–230
Introduction
Asthma is a heterogeneous disease that is driven by
variable mechanisms [1]. Several studies confirmed
the relationship between obesity and asthma.
Moreover, obesity was shown to have a negative
effect on asthma severity control and response to
treatment [2].
Obesity-related low-grade inflammation is a source of
various interleukins and adipokines such as leptin,
adiponectin, and resistin, which in turn possibly
affect airway inflammation and play a major role in
developing asthma [3].
Adiponectin is a protein with predominantly anti-
inflammatory properties [4]. On the contrary,
resistin is a member of resistin-like molecules family
and has proinflammatory effects [5].
© 2021 The Egyptian Journal of Chest Diseases and Tuberculosis | Published by Wolters Kluwer - Medknow
Introduction
The mechanisms connecting obesity and asthma are complex. Mechanical and
inflammatory factors have been proposed. Adipose tissues secrete various
adipokines. Some are proinflammatory such as resistin, whereas others are
anti-inflammatory such as adiponectin. We aimed to assess the serum levels of
adiponectin and resistin in patients with asthma and correlate them with asthma
control and severity as well as obesity parameters of the participants.
Patients and methods
This case–control study included 64 patients with asthma and 24 healthy controls.
They were all subjected to anthropometric measurements, asthma control test,
pulmonary function tests, skin prick test, and total serum immunoglobulin E levels.
Serum adiponectin and resistin concentrations were measured.
Results
Adiponectin and resistin levels were significantly higher among patients with
asthma than controls (P<0.001). Serum resistin levels were significantly higher
in obese patients with asthma than nonobese (P<0.001), whereas adiponectin
levels were not different between the two subgroups. Serum adiponectin level was
positively correlated with the duration of asthma, forced expiratory volume in 1 s
/forced vital capacity ratio, and resistin level, whereas resistin level was positively
correlated with age, sex, and body fat percentage. Resistin/adiponectin ratio was
positively correlated with body fat percentage.
Conclusion
Adiponectin and resistin levels were higher in patients with asthma. Moreover,
resistin was higher in obese than nonobese patients with asthma. These findings
could provide novel insights into their role in asthma and their potential use as
therapeutic targets.
Keywords:
adiponectin, bronchial asthma, obesity, resistin
Egypt J Chest Dis Tuberc 70:223–230
© 2021 The Egyptian Journal of Chest Diseases and Tuberculosis
2090-9950
Patients and methods
Study participants
This case–control study was conducted at Ain Shams
University Hospital after the approval of Ain Shams
University Ethics Committee (FWA 000017585). It
included 64 patients with bronchial asthma and 24
apparently healthy individuals of comparable age and
sex as a control group. Asthma diagnosis was established
according to the Global Initiative for Asthma (GINA)
guidelines [6]. They were further subdivided into three
groups according to their BMI: lean patients with
asthma (BMI, 18.5–24.9) (n=16), overweight patients
This is an open access journal, and articles are distributed under the terms
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DOI: 10.4103/ejcdt.ejcdt_142_20
 224 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 70 No. 2, April-June 2021
with asthma (BMI, 25.0–29.9) (n=16), and obese
patients with asthma (BMI >30) (n=32). Individuals
taking statins or systemic steroids (last dose within the
preceding 6 months), pregnant women, those taking
combined contraceptive pills, patients who had any
serious concurrent diseases, such as diabetes, coronary
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artery disease, or vasculitis, were excluded.
Methods
Anthropometric parameters were measured: BMI, waist
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circumference, waist/hip ratio, neck circumference, and
calculation of body fat percentage. Chest radiograph;
asthma control test (ACT); pulmonary function test; and
a skin prick test to common aeroallergens, including
house dust mite, Alternaria, hay dust, horsehair, grass
pollens, goat hair, cat hair, cotton dust, tobacco, pigeon,
dog hair, cockroach, straw, feather, wool, and latex,
were performed. Routine biochemical tests, including
random blood glucose, glycated hemoglobin (HbA1c),
erythrocyte sedimentation rate (ESR), C-reactive
protein, total serum immunoglobulin E (IgE), serum
adiponectin, and serum resistin levels were also done.
Asthma control test
Asthma control was rated according to American Lung
Society [7]: controlled=ACT score of more than or
equal to 20, partially controlled=ACT score of 16–19,
and uncontrolled=ACT score of less than 16.
Assessment of asthma severity
It was classified according to the National Heart, Lung,
and Blood Institute [8].
Body fat % (by US Navy method)
The body fat percentage calculator was used. The
patient was considered obese if body fat % was more
than 25 in men or more than 32 in females [9].
Overall, 5 ml of venous blood was obtained by
venipuncture from each participant, and 2 ml was
placed in an EDTA Vacutainer (Becton Dickinson
and Company, Franklin Lakes, New Jersey, USA)
tube for CBC and ESR and 3 ml collected into a gel
vacutainer tube (Becton Dickinson, Oxford, UK).
Serum was separated by centrifugation (3500 rpm,
15 min, 25°C) and then stored at −20°C until used for
analysis of HbA1c, total IgE, resistin, and adiponectin.
Complete blood picture was done using Coulter counter
(T660; Beckman Coulter, Brea, California, USA),
ESR was done by the Western green method, total
IgE levels (IU/ml) were done using enzyme-linked
immunosorbent assay kit (RIDASCREEN; R-
Biopharm, Darmstadt, Germany) (catalog number:
A0141), whereas HbA1c was performed using high-
performance liquid chromatography using Bio-Rad D10
machine (Bio-Rad Laboratories Inc., Hercules,
California, USA).
Resistin concentration (ng/ml) and adiponectin
concentration (mg/l) were evaluated using enzyme-
linked immunosorbent assay (SunRed Biological
Technology, Shanghai, China; catalog number: 201-
12-0339 and 201-12-1551, respectively) according to
the manufacturer’s instructions.
Statistical analysis
The software ‘IBM SPSS Statistics, version 25’ (IBM©
Corp., Armonk, NY, USA) was used for data analysis.
Numerical data of normal distribution were reported as
mean and SD using ‘independent samples t test,’
whereas numerical data with no normal distribution
were reported as median and interquartile range (IQR)
using ‘Mann–Whitney test’ when comparing two
groups and ‘Kruskal–Wallis test’ only when
comparing three groups. Categorical variables were
expressed as number and percentage using ‘χ 2 test.’
The relations between adiponectin level, resistin level,
and resistin/adiponectin ratio and the
clinicopathological parameters were calculated using
a correlation test. The diagnostic and predictive values
of adiponectin and resistin were investigated using
receiver-operating characteristic curve analysis.
Results
Clinical and laboratory data of whole study
participants
Clinical and laboratory data of all patients with asthma
and controls are presented in Table 1, with statistically
significant difference regarding total IgE, eosinophils
count, forced expiratory volume in 1 s (FEV1), and
FEV1/forced vital capacity (FVC) ratio. Within the 64
asthmatic patients, 46 were atopic and 18 were
nonatopic. They were classified as mild 29 (45.4%),
moderate 27 (42.2%), and severe (12.5%).
Serum adiponectin and resistin of whole study
participants
Serum adiponectin was significantly higher in
asthmatic patients compared with control group,
with median (IQR) of 2 μg/ml (1.8–3 μg/ml) and
0.75 μg/ml (0.4–1.6 μg/ml), respectively, with P
value less than 0.001. The same was detected for
serum resistin which was significantly higher among
the asthmatic group in comparison with control group,
with median (IQR) of 3 ng/ml (2.5–5 ng/ml) and
1.2 ng/ml (0.5–1.95 ng/ml), respectively, with P
value less than 0.001 (Table 1).
 Asthma and obesity Hosny et al 225

Table 1 Demographic and clinical data and laboratory and pulmonary function results of patients and controls
Variables Patients with asthma (N=64) Control (N=24) P value
Age (years) 33.96±12.28 32.33±12.86 0.584a
Sex
Male 24 (37.5) 8 (33.3) 0.717b
Female 40 (62.5) 16 (66.7)
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BMI 29.50±6.10 29.23±6.15 0.857a

Obese 32 (50) 12 (50) 1b
Nonobese 32 (50) 12 (50)
Waist circumference (male) 96.60±12.46 101.62±15.84 0.364a
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Waist circumference (female) 102.76±20.50 96.28±16.77 0.267a

Obese 41 (64.1) 14 (58.3) 0.621b
Nonobese 23 (35.9) 10 (41.7)
W/H ratio % (male) 0.91±0.04 0.98±0.08 0.034a
W/H ratio % (female) 0.89±0.12 0.85±0.10 0.364a
Obese 37 (57.8) 16 (66.7) 0.450b
Nonobese 27 (42.2) 8 (33.3)
Body fat % (male) 25.61±6.57 28.86±8.44 0.268a
Body fat % (female) 48.09±11.48 44.87±11.49 0.348a
Obese 51 (79.7) 19 (79.2) 0.957b
Nonobese 13 (20.3) 5 (20.8)
Neck circumference (male) 37.39±3.32 36.87±3.17 0.701a
Neck circumference (female) 34.98±3.12 33.90±3.17 0.249a
Obese 46 (71.9) 15 (62.5) 0.396b
Nonobese 18 (28.1) 9 (37.5)
Total IgE (IU/l) 101.35 (30–203) 39.1 (19.25–53.75) 0.001c
3 3
Eosinophils (10 cells/mm ) 0.13 (0.09–0.29) 0.11 (0.10–0.13) 0.044c
Pulmonary functions: FEV1% 78.64±20.89 92.36±11.51 0.003a
FVC% 85.95±17.12 92.19±7.23 0.088a
FEV1/FVC% 78.01±13.02 88.47±4.88 <0.001a
ESR 18.04±8.79 14.87±3.39 0.017a
CRP 5.04±2.29 4.60±1.17 0.368a
HbA1c 5.39±0.34 5.16±0.25 0.004a
Adiponectin (μg/ml) 2 (1.8–3) 0.75 (0.4–1.6) <0.001c
Resistin (ng/ml) 3 (2.5–5) 1.2 (0.5–1.95) <0.001c
Adiponectin/resistin 1.15 (0.96–1.39) 1.09 (0.9–1.4) 0.690c
ACT: controlled 13 (20.3)
Partially controlled 22 (34.4)
Uncontrolled 29 (45.3)
Atopic 46 (71.87)
Nonatopic 18 (28.12)
Asthma severity
Mild intermittent and persistent 29 (45.4)
Moderate 27 (42.2)
Severe 8 (12.5)
Data are presented as mean±SD, ratio, n (%), or median (interquartile range). ACT, asthma control test; CRP, C-reactive protein; ESR,
erythrocyte sedimentation rate; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; HbA1c, glycated hemoglobin; IgE,
immunoglobulin E; W/H ratio %, waist–hip ratio. aIndependent t test. bχ 2 test. cMann–Whitney test.

Clinical and laboratory data of obese and nonobese
patients with asthma
Obese patients with asthma had a higher age (38±12.34)
compared with lean and overweight patients with asthma
(26.44±11.87 and 33.44±9.05) (P=0.007). Moreover,
there was female predominance [24 (75%)] among
obese asthmatic compared with lean and overweight
subgroups; other than that, the three groups were
comparable regarding asthma control and severity,
pulmonary functions, and laboratory data (Table 2).
Serum adiponectin and resistin levels in obese and
nonobese (lean and overweight) patients with asthma
Median serum resistin level was higher among obese
patients with asthma [4.00 ng/ml (2.63–6.88 ng/ml)]
compared with lean and overweight patients with
asthma [3.00 ng/ml (2.50–4.75 ng/ml) and 2.50 ng/ml
(2.00–2.60 ng/ml), respectively] (P=0.011). Median
serum adiponectin level was higher among the lean
subgroup [2.60 μg/ml (1.85–3.80 ng/ml)] than the
obese and overweight subgroups [2.00 μg/ml
 226 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 70 No. 2, April-June 2021

Table 2 Demographic, clinical, and laboratory data of lean, overweight, and obese patients with asthma
Asthmatic (N=64)
Variables Lean Overweight Obese P value
n (%) 16 (25) 16 (25) 32 (50)
Age (years) 26.44±11.87 33.44±9.05 38.00±12.35 0.007a
Sex
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Male 7 (43.8) 9 (56.3) 8 (25) 0.091b

Female 9 (56.3) 7 (43.8) 24 (75)
ACT: controlled 3 (18.8) 3 (18.8) 7 (21.9)
Partially controlled 7 (43.8) 4 (25) 11 (34.4) 0.818b
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Uncontrolled 6 (37.5) 9 (56.3) 14 (43.7)

Asthma severity
Mild intermittent and persistent 8 (50) 7 (43.8) 14 (43.7)
Moderate 8 (50) 8 (50) 11 (34.4) 0.216b
Severe 0 1 (6.3) 7 (21.9)
FEV1% 72.26±12.42 85.33±26.62 78.49±20.64 0.211a
FVC% 81.41±6.74 92.61±21.73 84.90±17.62 0.161a
FEV1/FVC% 77.02±13.96 77.65±11.40 78.69±13.64 0.910a
Total IgE (IU/ml) 46.50 (26.25–143.50) 121.50 (57.68–239.50) 110 (24.75–197.25) 0.307c
3 3
Eosinophils (10 cells/mm ) 0.13 (0.09–0.37) 0.14 (0.10–0.36) 0.13 (0.09–0.29) 0.714c
Adiponectin (μg/ml) 2.60 (1.85–3.80) 1.95 (1.58–2.18) 2.00 (1.8–3) 0.124c
Resistin (ng/ml) 3.00 (2.50–4.75) 2.50 (2.00–2.60) 4.00 (2.63–6.88) 0.011c
Resistin/adiponectin ratio 1.06 (0.88–1.35) 1.12 (1.02–1.38) 1.26 (1.01–1.40) 0.398c
Data are presented as mean±SD, ratio, n (%), or median (interquartile range). ACT, asthma control test; FEV1, forced expiratory volume
in 1 s; FVC, forced vital capacity; IgE, immunoglobulin E. aOne-way analysis of variance test. bχ 2 test. cKruskal–Wallis test.

Figure 1

Serum adiponectin distribution in different categories of BMI in patients with asthma.

(1.8–3 ng/ml) and 1.95 μg/ml (1.58–2.18 ng/ml),
respectively] but did not reach significant level
(P=0.124) (Fig. 1).
Nevertheless, resistin/adiponectin ratios were not
significantly different (P=0.227) (Table 2).
Adiponectin and resistin levels in relation to clinical
and laboratory data of patients with asthma
Women exhibited higher serum resistin levels in
comparison with their male counterparts (P<0.001).
Additionally, obese patients with asthma (assessed by
both BMI and body fat %) revealed higher serum
resistin levels as compared with nonobese (P=0.01
and 0.02, respectively) (Table 3).
Serum adiponectin was found to correlate positively
and significantly with asthma duration (r=0.308,
P=0.013) and FEV1/FVC ratio (r=0.247,
P=0.049). Resistin/adiponectin ratio correlated
positively with body fat percentage (r=0.260,
P=0.038) (Table 4).
 Asthma and obesity Hosny et al 227

Table 3 Relation between serum adiponectin, serum resistin, and different clinicopathological factors among patients with
asthma
Variables Serum adiponectin (μg/ml) [median P Serum resistin (ng/ml) [median P value
(IQR)] value (IQR)]
Sex
Male 2.00 (1.8–2.8) 0.758 a
2.50 (2–3) <0.001a
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Female 2.00 (1.5–3) 4.00 (2.6–7.5)

BMI
Obese 2.00 (1.8–3) 0.771a 4.00 (2.62–6.87) 0.013a
Nonobese 2.00 (1.8–3) 2.55 (2–4)
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Body fat percent

Obese 2.00 (1.5–3) 0.415a 3.50 (2.25–5) 0.027a
Nonobese 2.20 (1.85–3) 2.50 (2–3)
W/H ratio
Obese 2.00 (1.65–2.2) 0.102a 3.00 (2.25–5) 0.526a
Nonobese 2.20 (1.8–3.8) 3.00 (2.5–5)
Neck circumference
Obese 2.00 (1.8–2.62) 0.583a 3.00 (2.5–5) 0.753a
Nonobese 2.10 (1.72–3.2) 3.00 (2.37–4.25)
Waist circumference
Obese 2.00 (1.5–2.75) 0.178a 4.00 (2.5–5) 0.079a
Nonobese 2.10 (2–3) 2.60 (2.5–4)
Atopic 2 (1.8–2.27) 0.395a 3 (2.5–5) 0.857a
Nonatopic 2 (1.72–3.8) 3 (2.37–5)
ACT
Controlled 2.00 (1.65–2.75) 0.660b 3.00 (1.75–4.5) 0.638b
Partially controlled 2.00 (1.87–3.2) 3.00 (2.5–4.62)
Uncontrolled 2.10 (1.65–2.2) 3.00 (2.25–7.5)
Asthma severity
Mild, intermittent, and 2.1 (1.8–3) 0.068b 3 (2.5–4.75) 0.646b
persistent
Moderate 2.00 (1.5–3) 4.00 (2.5–7.5)
Severe 1.75 (1–2) 2.65 (2.12–6.5)
Family history
Positive 2.05 (1.72–3.2) 0.719a 2.85 (2.5–5) 0.552a
Negative 2.00 (1.8–3) 3.00 (2.5–5.62)
Associated rhinitis
Positive 2.00 (1.8–3) 0.608a 3.00 (2.5–5) 0.360a
Negative 2.00 (1.5–3) 3.00 (2.25–4)
a b
ACT, asthma control test; W/H ratio %, waist–hip ratio. Mann–Whitney test. Kruskal–Wallis test.

Serum adiponectin and resistin as a biomarker for
asthma
Receiver-operating characteristic curve showed that at a
cutoff value more than or equal to 1.7 for serum
adiponectin, the sensitivity of the test was 78.1% and
specificity was 79.2%, and at cutoff value of more than
or equal to 2.25 ng/ml for serum resistin, the sensitivity
of the test was 79.7% and specificity was 100%
(P<0.001) in differentiating patients with asthma and
those without asthma (Table 5).
Discussion
In this study, serum adiponectin was higher in
the asthmatic group than the control group. This
finding is consistent with that of Ballantyne et al.
[10], who elicited similar results, although it did
not reach fundamental significance. In contrast,
other studies revealed normal [11,12] or decreased
serum level of adiponectin in patients with asthma
[13,14].
The observed increase in adiponectin in patients with
asthma in this study could be attributed to the female
predominance, as there is marked sexual dissimilarity in
the distribution of adiponectin isoforms. Women
usually have higher circulating concentrations of
total adiponectin, as testosterone production in
males decreases systemic adiponectin concentrations,
particularly the high-molecular-weight isoform [15].
Another possible reason is that our study included
more mild and moderate cases than severe cases, as
Sood [15] concluded that mild and moderate cases
 228 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 70 No. 2, April-June 2021

Table 4 Correlation between serum adiponectin, serum resistin, and resistin/adiponectin ratio and other study parameters
Serum adiponectin level Serum resistin (μg/ml) Resistin/adiponectin ratio
(μg/ml)
Asthmatic group (N=64) ra P value ra P value ra P value
Resistin (ng/ml) 0.304 0.015
Age (years) −0.084 0.509 −0.013 0.920 0.096 0.450
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BMI % 0.047 0.714 0.138 0.278 0.186 0.141

Neck circumference 0.028 0.828 −0.009 0.943 −0.082 0.522
Waist circumference −0.059 0.643 0.080 0.529 0.175 0.166
W/H ratio −0.131 0.303 0.012 0.928 0.103 0.418
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Body fat % 0.063 0.620 0.196 0.120 0.260 0.038

ACT −0.062 0.624 −0.055 0.666 −0.086 0.501
Total IgE (IU/ml) −0.043 0.736 −0.118 0.351 −0.077 0.543
FEV1% 0.152 0.230 −0.022 0.861 −0.077 0.544
FVC % 0.123 0.331 −0.073 0.569 −0.110 0.388
FEV1/FVC % 0.247 0.049 0.096 0.449 −0.021 0.867
CRP −0.071 0.579 −0.069 0.587 0.148 0.244
ESR 0.241 0.056 0.109 0.393 0.025 0.848
HbA1c 0.136 0.287 −0.106 0.410 −0.167 0.190
Duration 0.308 0.013 0.076 0.552 −0.012 0.924
ACT, asthma control test; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FEV1, forced expiratory volume in 1 s; FVC,
forced vital capacity; HbA1c, glycated hemoglobin; IgE, immunoglobulin E; W/H ratio %, waist–hip ratio.

Table 5 Receiver-operating characteristic curve for serum adiponectin and resistin

χ 2 test
Cutoff AUC 95% CI Sensitivity Specificity PPV NPV Accuracy P Significance
point (%) (%) (%) (%) (%) value
Adiponectin ≥1.7 μg/ml 0.889 0.821–0.958 78.1 79.2 90.9 57.6 78.4 <0.001 S
Resistin ≥2.25 ng/ 0.933 0.884–0.981 79.7 100 100 64.9 85.3 <0.001 S
ml
AUC, area under the curve; NPV, negative predictive value; PPV, positive predictive value; S, significant.

exhibit higher serum adiponectin levels than severe was higher among obese patients with asthma but was
ones; this is especially true in women. not statistically significant.

Moreover, in this study, serum adiponectin was
inversely related to asthma severity. Severe cases had
the lowest serum adiponectin levels, and serum
adiponectin was positively correlated with asthma
duration and FEV1/FVC ratio, so it reflects the
potential protective effect of adiponectin in asthma.
Similarly previous studies revealed that serum
adiponectin concentrations are protective against
asthma, especially among premenopausal women and
peripubertal girls [16]. Moreover, it was associated
with an increase in pulmonary functions and a
reduction in asthma severity, in addition to few
asthma symptoms and fewer exacerbations, and high
FEV1/FVC ratio [15–17].
Asthmatic patients in the current study were classified
according to BMI into three groups: obese, overweight,
and lean. No considerable variation was detected
regarding pulmonary functions, asthma control, total
IgE, or eosinophil count. However, asthma severity
Similarly, Al Ghobain [18] observed no major
difference between obese and nonobese patients with
asthma regarding FEV1, FVC, and FEV1/FVC ratio.
In contrast, Galal et al. [19] found that FEV1%, FVC
%, FEF 25–75%, and FEV1/FVC were significantly
decreased in obese asthmatic than overweight or
nonobese patients with asthma.
In the present study, serum adiponectin levels did not
differ between obese and nonobese (lean and overweight)
patients with asthma. On the contrary, Samir et al. [20]
and Salah et al. [21] observed that serum adiponectin was
significantly low in obese asthmatic patients as compared
with nonobese patients with asthma. Our explanation to
this finding is that our nonobese patients with asthma
included lean (BMI, 18.5–24.9) and overweight (BMI,
25.0–29.9), and in comparing serum adiponectin
between obese and lean patients with asthma, it was
higher in lean than obese patients but did not achieve
significant difference, possibly owing to the small sample

size. However, no significant difference between obese
and overweight was detected. Similarly, in a cross-
sectional study about asthma among patients with
different BMI, serum adiponectin was higher in lean
than overweight and obese, with no significant difference
being found between obese and overweight [15].
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Another important finding in the current study was
that serum resistin levels were high among patients
with asthma patients, especially females, when
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 06/27/2023
compared with controls. Furthermore, obese patients
showed the highest levels of resistin compared with
nonobese. Several studies have investigated resistin
levels in patients with asthma. Larochelle et al. [22]
found that patients with asthma have higher resistin
levels. Furthermore, the levels increased with the
severity of asthma, whereas Kim et al. [23] suggested
a protective effect of resistin in asthma. However, Arshi
et al. [24] did not detect differences in resistin levels
between patients with asthma and controls.
Increased serum level of resistin in patients with
asthma could be attributed to its proinflammatory
effects on the lung, which in turn leads to increased
airway inflammation and asthma [8]. Similarly, Al-Asy
and Mabrouk [25] detected that serum resistin levels
were significantly higher in asthmatic children
compared with the control group and in obese than
nonobese patients with asthma. This relationship may
be explained by the fact that resistin is an endogenous
agonist of Toll-like receptor 4, which causes activation
of different genes involved in asthmatic inflammation
through the NF-kB pathway.
Upon calculation of the resistin/adiponectin ratio in this
study, it showed no difference between asthmatic and
control groups. Although the ratio did not differ between
obese and nonobese patients with asthma, it was positively
correlated to the body fat percentage but not with other
parameters of obesity. In accordance with these results,
Wood et al. [26] mentioned that plasma resistin was
higher in patients with asthma compared with controls,
and resistin/adiponectin ratio was increased in obese
compared with nonobese patients with asthma and
nonobese controls. Similarly, Ballantyne et al. [10]
stated that serum resistin levels and resistin/
adiponectin ratio were higher in asthma compared
with controls; however, serum resistin levels were not
different according to obesity, sex, or asthma severity.
In the current study, adiponectin was associated with
asthma severity and FEV1/FVC ratio, whereas both
resistin and R/A ratio were not associated with asthma
severity/control but associated with obesity.
Asthma and obesity Hosny et al 229
Conclusion
These data suggest that both resistin and adiponectin
are implicated in the pathogenesis of obese asthma
phenotype and are targets for potential targeted therapy
for the management of obese patients with asthma.
Serum adiponectin levels may have a potential
protective role in asthma, especially among female
patients.
Limitation of the study
The limitations of the current study are the small
sample size of the study population, especially
among nonobese patients with asthma, and large
scale multicenter studies should be performed to
further elucidate the importance of evaluating serum
levels of adiponectin and resistin in patients with
asthma. Moreover, longitudinal studies might aid a
better understanding of the causal relationship between
obesity and asthma.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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