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Original Research: Asthma |

The Effect of Omega-3 Fatty Acids on Bronchial Hyperresponsiveness, Sputum Eosinophilia, and Mast Cell Mediators in AsthmaOmega-3 Fatty Acid Supplements in Asthma

John D. Brannan, PhD; Johan Bood, PhD; Ahmad Alkhabaz, MD; David Balgoma, PhD; Joceline Otis, BSc; Ingrid Delin, BSc; Barbro Dahlén, MD, PhD; Craig E. Wheelock, PhD; Parameswaran Nair, MD, PhD; Sven-Erik Dahlén, MD, PhD; Paul M. O’Byrne, MB, FCCP
Author and Funding Information

From the Firestone Institute for Respiratory Health (Drs Brannan, Alkhabaz, Nair, and O’Byrne and Ms Otis), St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada; and Department of Medical Biochemistry and Biophysics (Drs Balgoma and Wheelock), National Institute of Environmental Medicine (Drs Bood, Balgoma, and S.-E. Dahlén and Ms Delin), Department of Medicine, Karolinska University Hospital Huddinge (Drs Bood and B. Dahlén), and Centre for Allergy Research (Drs Bood, B. Dahlén, Wheelock, and S.-E. Dahlén and Ms Delin), Karolinska Institutet, Stockholm, Sweden.

CORRESPONDENCE TO: John D. Brannan, PhD, Department of Respiratory and Sleep Medicine, Westmead Hospital, Darcy Rd, Westmead, NSW 2145, Australia; e-mail: john.brannan@sydney.edu.au


Part of this article has been presented in abstract form (Brannan JD, Alkhabaz A, Otis J, et al. Effect of omega-3 fatty acid [O3FA] from fish oils on mannitol-induced airway hyperresponsiveness [AHR] and sputum eosinophils in patients with asthma. Eur Respir J. 2009;34[suppl 33]:333s).

FUNDING/SUPPORT: Dr Brannan was supported by an Asthma Foundation of New South Wales (Australia) Martin Hardie Traveling Fellowship. Dr Nair holds a Canada Research Chair in Airway Inflammometry. Dr Balgoma was supported by the Innovative Medicines Initiative project U-BIOPRED (Unbiased Biomarkers in Prediction of Respiratory Distress Outcomes). The clinical study was funded by the Firestone Institute for Respiratory Health, and the work at Karolinska Institutet was supported by funding to Drs B. Dahlén, Wheelock, and S.-E. Dahlén from several Swedish sources (Heart and Lung Foundation, Medical Research Council, Stockholm County Council, VINNOVA, the Åke Wibergs Stiftelse, Jeanssons Stiftelse, Fredrik and Ingrid Thurings Stiftelse, and Centre for Allergy Research).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):397-405. doi:10.1378/chest.14-1214
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BACKGROUND:  Omega-3 fatty acid supplements have been reported to inhibit exercise-induced bronchoconstriction (EIB). It has not been determined whether omega-3 supplements inhibit airway sensitivity to inhaled mannitol, a test for bronchial hyperresponsiveness (BHR) and model for EIB in people with mild to moderate asthma.

METHODS:  In a double-blind, crossover trial, subjects with asthma who had BHR to inhaled mannitol (n = 23; 14 men; mean age, 28 years; one-half taking regular inhaled corticosteroids) were randomized to omega-3 supplements (4.0 g/d eicosapentaenoic acid and 2.0 g/d docosahexaenoic acid) or matching placebo for 3 weeks separated by a 3-week washout. The primary outcome was the provoking dose of mannitol (mg) to cause a 15% fall in FEV1 (PD15). Secondary outcomes were sputum eosinophil count, spirometry, Asthma Control Questionnaire (ACQ) score, serum triacylglyceride level, and lipid mediator profile in urine and serum.

RESULTS:  PD15 (geometric mean, 95% CI) to mannitol following supplementation with omega-3s (78 mg, 51-119 mg) was not different from placebo (88 mg, 56-139 mg, P = .5). There were no changes in sputum eosinophils (mean ± SD) in a subgroup of 11 subjects (omega-3, 8.4% ± 8.2%; placebo, 7.8% ± 11.8%; P = .9). At the end of each treatment period, there were no differences in FEV1 % predicted (omega-3, 85% ± 13%; placebo, 84% ± 11%; P = .9) or ACQ score (omega-3, 1.1% ± 0.5%; placebo, 1.1% ± 0.5%; P = .9) (n = 23). Omega-3s caused significant lowering of blood triglyceride levels and expected shifts in serum fatty acids and eicosanoid metabolites, confirming adherence to the supplements; however, no changes were observed in urinary mast cell mediators.

CONCLUSIONS:  Three weeks of omega-3 supplements does not improve BHR to mannitol, decrease sputum eosinophil counts, or inhibit urinary excretion of mast cell mediators in people with mild to moderate asthma, indicating that dietary omega-3 supplementation is not useful in the short-term treatment of asthma.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT00526357; URL: www.clinicaltrials.gov.

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