{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:42:51Z","timestamp":1791405771915,"version":"4.3.3"},"reference-count":48,"publisher":"European Respiratory Society (ERS)","issue":"3","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/publications.ersnet.org\/user-licence"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2026,4,20]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity is associated with poorer asthma outcomes and an increased risk of exacerbations, but the underlying mechanisms remain incompletely understood. Small airway dysfunction (SAD) may represent a key mechanistic link between excess body weight and adverse asthma outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicentre observational study, adult patients with asthma underwent clinical characterisation, spirometry and impulse oscillometry (IOS). SAD was defined using a composite criterion based on small airway resistance (frequency dependence of resistance between 5 and 20\u2005Hz (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>5\u201320<\/jats:sub>\n                      )), reactance area (A\n                      <jats:italic>X<\/jats:italic>\n                      ) and ratio of peripheral airway to total airway resistance ((\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>5\u201320<\/jats:sub>\n                      )\/\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>5<\/jats:sub>\n                      ). Associations between body mass index (BMI), SAD and severe asthma exacerbations were assessed using multivariable regression models. Non-linear relationships were explored using generalised additive models, and mediation analyses quantified the contribution of SAD to the obesity\u2013exacerbation association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1169 patients, IOS-defined SAD was significantly more prevalent in individuals with BMI \u226530\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      . Increasing BMI was associated with worse IOS parameters (p&lt;0.0001), following a non-linear pattern with steeper deterioration beyond BMI values of \u223c28\u201330\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      . SAD was independently associated with obesity (adjusted OR 2.11, 95% CI 1.56\u20132.86) and with severe asthma exacerbations in the previous year (adjusted OR 2.01, 95% CI 1.53\u20132.65) (both p&lt;0.0001). Mediation analyses showed that SAD accounted for 26\u201341% of the association between obesity and exacerbation risk (p=0.004 and p=0.03). Spirometry indices provided limited additional information.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Oscillometry-defined SAD represents a non-linear functional trait underlying the association between obesity and severe asthma exacerbations, supporting its clinical relevance in obese patients with asthma and identifying SAD as a potential treatable trait.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.00150-2026","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:25:33Z","timestamp":1779377133000},"page":"2600150","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Small airway dysfunction may mediate the association between body mass index and severe asthma 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