This randomized controlled trial evaluated whether a structured, dietitian-supported weight management program (Counterweight-Plus Programme, or CWP) could improve asthma-related outcomes over one year in adults with obesity and difficult-to-treat asthma. Compared with usual care (UC), patients in the CWP group achieved significantly greater and sustained weight loss (median –14 kg; mean –12.8%) and were more likely to experience clinically meaningful improvements in asthma-related quality of life. While no significant between-group differences were found in asthma control (ACQ-6), within-group improvements in the CWP arm—particularly in quality of life and reduction in high-dose corticosteroid use—suggest the potential utility of targeting obesity as a modifiable trait in asthma management.
Post hoc analyses revealed that patients who lost ≥10% of their body weight with CWP showed the greatest improvements in asthma control and quality of life. Additionally, 23.5% of CWP participants achieved asthma remission, though this was not statistically significant due to small sample size. Notably, patients with type 2-high asthma appeared to respond better to CWP than those with type 2-low profiles, challenging traditional assumptions about obesity-linked asthma phenotypes. Given its feasibility, sustained weight loss, and positive asthma-related signals, the CWP warrants larger trials to confirm its clinical utility as a nonpharmacologic intervention in this high-risk population.
Reference: Sharma V, Ricketts HC, McCombie L, et al. A 1-Year Weight Management Program for Difficult-to-Treat Asthma With Obesity: A Randomized Controlled Study. Chest. 2025 Jan;167(1):42-53. doi: 10.1016/j.chest.2024.09.042. Epub 2024 Oct 18. PMID: 39427706; PMCID: PMC11752128.
