Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ)

1990-472X

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

11597

10.18499/1990-472X-2026-27-1-%p

The role of diet therapy in multidisciplinary rehabilitation of patients with asthma, obesity, and multimorbidity within the Treatable Traits concept

Tribuntseva

Ludmila

PhD, Associate Professor, Head of the Department of Therapeutic Disciplines at the Institute of Continuing Educationtribunzewa@yandex.ruProzorova

Galina

MD, Associate Professor, Professor of the Department of Therapeutic Disciplines at the Institute of Advanced Trainingvp.idpo@vrngmu.ruOlysheva

Irina

Candidate of Medical Sciences Assistantovpidpo@yandex.ru

N.N. Burdenko Voronezh State Medical University of the Russian Ministry of Health

06042026

271

03042026

2026

Aim. To assess the effectiveness of multicomponent rehabilitation programs with diet therapy as a core element for the management of treatable traits (including obesity) for patients with asthma and multimorbidity. Materials and methods. 70 patients with asthma, multimorbidity and obesity were divided into two groups: the main group (n=35, rehabilitation program) and the control group (n=35). The rehabilitation program included interventions aimed at weight reduction and correction of eating behavior. Assessments included waist circumference, height, weight, body mass index (BMI), asthma control (Asthma Control Questionnaire-5, ACQ-5), exercise tolerance (6-minute walk test), and levels of Vitamin D, interleukin-6, interleukin-4, tumor necrosis factor alpha, leptin. Results. The groups were comparable at baseline in all parameters. Following the rehabilitation program, group 1 demonstrated a significant reduction in BMI and waist circumference, along with improved asthma control: the ACQ-5 score decreased by 0.600.16 (p0.05), which was associated with increased exercise tolerance (6-minute walk test). In Group 2, no significant changes in these parameters were observed. Vitamin D levels increased in Group 1, while pro-inflammatory cytokine levels (IL-6, TNF-) and leptin decreased significantly (p0.05). No significant changes in these parameters were noted in the control group. Conclusion. A multicomponent rehabilitation program focusing on diet therapy as part of a treatable traits strategy significantly improves asthma control for patients with obesity and multimorbidity compared to standard care. The integration of personalized dietary interventions with exercise and physiotherapy is warranted to achieving asthma control and prevent exacerbations.

Aim. To assess the effectiveness of multicomponent rehabilitation programs with diet therapy as a core element for the management of treatable traits (including obesity) for patients with asthma and multimorbidity. Materials and methods. 70 patients with asthma, multimorbidity and obesity were divided into two groups: the main group (n=35, rehabilitation program) and the control group (n=35). The rehabilitation program included interventions aimed at weight reduction and correction of eating behavior. Assessments included waist circumference, height, weight, body mass index (BMI), asthma control (Asthma Control Questionnaire-5, ACQ-5), exercise tolerance (6-minute walk test), and levels of Vitamin D, interleukin-6, interleukin-4, tumor necrosis factor alpha, leptin. Results. The groups were comparable at baseline in all parameters. Following the rehabilitation program, group 1 demonstrated a significant reduction in BMI and waist circumference, along with improved asthma control: the ACQ-5 score decreased by 0.60±0.16 (p<0.05), which was associated with increased exercise tolerance (6-minute walk test). In Group 2, no significant changes in these parameters were observed. Vitamin D levels increased in Group 1, while pro-inflammatory cytokine levels (IL-6, TNF-α) and leptin decreased significantly (p<0.05). No significant changes in these parameters were noted in the control group. Conclusion. A multicomponent rehabilitation program focusing on diet therapy as part of a treatable traits strategy significantly improves asthma control for patients with obesity and multimorbidity compared to standard care. The integration of personalized dietary interventions with exercise and physiotherapy is warranted to achieving asthma control and prevent exacerbations.

бронхиальная астма, контроль, поддающиеся лечению признаки, ожирение, мультиморбидность, диетотерапия, реабилитация

1. Guarnieri G, Pozza M, Vianello A. The role of pulmonary rehabilitation in severe asthma: a comprehensive review. Front Med (Lausanne). 2025 Oct 28;12:1709710. doi: 10.3389/fmed.2025.1709710.

2. Varkonyi-Sepp J, Freeman A, Ainsworth B, et al. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J Pers Med. 2022 Aug 31;12(9):1435. doi: 10.3390/jpm12091435.

3. Wu W, McDonald VM, Wang G, Gibson PG. The value of treatable traits across the spectrum of adult asthma severity. Chin Med J Pulm Crit Care Med. 2025 Sep 18;3(3):182-192. doi: 10.1016/j.pccm.2025.08.002.

4. Трибунцева Л. В., Бурлачук В. Т., Раскина Е. А., Кожевникова С. А. Бронхиальная астма и ожирение – патологический тандем: роль питания // Лечащий Врач. 2021; 4 (24): 7-11. DOI: 10.51793/OS.2021.35.60.00

5. Лапик И.А., Гаппарова К.М. Диетотерапия при ожирении и бронхиальной астме. Клиническая медицина. 2025;103(8-9):584–588. DOI: http://dx.doi.org/10.30629/0023-2149-2025-103-8-9-584-588

6. Мартюшев-Поклад А.В., Янкевич Д.С., Петрова М.В., Савицкая Н.Г. Гиперинсулинемия и возрастзависимые заболевания: взаимосвязь и подходы к лечению // Вопросы питания. 2022. Т. 91, № 3. С. 21–31. DOI: https://doi.org/10.33029/0042-8833-2022-91-3-21-31

7. Patel S, Yan Z, Remedi MS. Intermittent fasting protects β-cell identity and function in a type-2 diabetes model. Metabolism. 2024;153:155813. DOI: 10.1016/j.metabol.2024.155813.

8. Трибунцева Л.В., Будневский А.В., Чопоров О.Н., Олышева И.А., Раскина Е.А. Оценка уровня витамина D у пациентов с бронхиальной астмой и мультиморбидной патологией // Российский семейный врач. - 2025. - Т. 29. - №3. - C. 45-54. doi: 10.17816/RFD678170

9. Marie B Demay et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 8, August 2024, Pages 1907–1947, https://doi.org/10.1210/clinem/dgae290

10.

10. Abd El-Kader MS, Al-Jiffri O, Ashmawy EM. Impact of weight loss on markers of systemic inflammation in obese Saudi children with asthma. Afr Health Sci. 2013 Sep;13(3):682-8. doi: 10.4314/ahs.v13i3.23.

11.

11. Vassilopoulou E, Guibas GV, Papadopoulos NG. Mediterranean-Type Diets as a Protective Factor for Asthma and Atopy. Nutrients. 2022 Apr 27;14(9):1825. doi: 10.3390/nu14091825. PMID: 35565792; PMCID: PMC9105881.

12.

12. Holt R, Holt J, Jorsal MJ, et al. Weight Loss Induces Changes in Vitamin D Status in Women With Obesity But Not in Men: A Randomized Clinical Trial. J Clin Endocrinol Metab. 2025 Jul 15;110(8):2215-2224. doi: 10.1210/clinem/dgae775.

13.

13. Born CDC, Bhadra R, D'Souza G, et al. Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review. Nutrients. 2024;16(10):1515. DOI: 10.3390/nu16101515