Pathophysiological factors that may be implicated include metabolic and microbiome dysfunction (36), obesity-related local and systemic inflammation (36), genetic predisposition (37), increased mechanical load/stress on the lungs (38) and obesity-related hormonal changes such as an increase in leptin; an adipocyte-derived hormone which has been found to increase airway inflammation (37). Here, LEP is linked to obesity due to melanocortin 4 receptor deficiency.