This phase IV randomized controlled trial is designed to evaluate the effects of chromium picolinate supplementation in obese adults with stable asthma. A total of 60 participants will be recruited from Ain Shams University Hospitals and randomly assigned to receive either 400 mcg of chromium picolinate daily or a matching placebo for 12 weeks, in addition to standard asthma therapy.

The study aims to explore the interaction between metabolic dysfunction and asthma, as obesity-related asthma is often associated with systemic inflammation, insulin resistance, and dyslipidemia. These factors may contribute to poorer asthma control and impaired pulmonary function, and therefore represent potential targets for adjunctive therapeutic interventions such as chromium supplementation.

Study Design and Setting This study is a phase IV randomized controlled clinical trial (RCT) involving 60 adult patients diagnosed with asthma. Participants will be recruited from the outpatient clinic and pulmonary function unit of the Chest Department at Ain Shams University Hospitals.

Study Type: Phase IV randomized controlled clinical trial (RCT) Study Setting: Outpatient clinic and pulmonary function unit, Chest Department, Ain Shams University Hospitals Study Population: Adult patients with asthma, obesity, and diabetes mellitus

Sampling and Randomization Participants will be randomly assigned to study groups using computer-generated randomization sequences. Allocation concealment will be ensured through the use of sealed, opaque envelopes.

Ethical Considerations

The study protocol will be explained clearly to all eligible participants prior to enrollment.

The study will commence only after obtaining approval from the Ethical Committee of the Faculty of Medicine, Ain Shams University.

Written informed consent will be obtained from all participants prior to inclusion.

Participant safety will be prioritized, and all efforts will be made to minimize potential risks.

Confidentiality and anonymity of participant data will be strictly maintained. All participants will have an equal chance of being assigned to either study group.

No deceptive practices will be used during the study. Participants will have the right to withdraw from the study at any time without any consequences.

Study Procedures

All eligible participants will undergo the following assessments:

Demographic Data Collection: Age, sex, smoking status, and body mass index (BMI) Clinical Assessment: Detailed medical history including environmental exposures, potential risk factors, comorbidities, and duration of disease

Concomitant Care All participants will continue receiving standard asthma therapy throughout the study period.

Participants will be instructed to maintain a consistent intake of chromium-rich foods during the study to avoid dietary confounding.

Inclusion Criteria:

• Age: 18-65 years
• Confirmed asthma diagnosis according to GINA criteria (7)
• Asthma stable for at least 4 weeks (no acute exacerbation)
• BMI of 30 kg/m² (obese category)
• Stable inhaled corticosteroid + LABA regimen in the last 4 weeks
• The patient is compliant on his asthma medication
• Willing and able to provide informed consent
• willing to continue in the study, follow investigator instructions

Exclusion Criteria:

• - Recent asthma exacerbation (within the last 4 weeks)
• Any change in asthma medications within 4 weeks
• renal or hepatic disease
• Use of lipid-lowering drugs or supplements in the past 3 months
• Use of Vitamin C, prostaglandin inhibitors, such as aspirin, oxalate, and antacids
• Current pregnancy or lactation
• Known allergy to chromium or adverse reaction to supplementation
• Participation in another interventional study in the past month
• History of heavy metal toxicity or chromium sensitivity
• Being on any weight control diet
• Being on a supplement containing chromium

De-identified individual participant data underlying the results reported in publications arising from this study, including demographic, clinical, and outcome data, will be made available.

De-identified individual participant data will be made available beginning 6 months after publication of the primary study results and will be available indefinitely.

Data will be available upon reasonable request to the principal investigator. Requests will be reviewed for scientific merit and compliance with applicable ethical and regulatory requirements. Data-sharing agreements may be required before access is granted.