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Journal Reading

Prospective Study on the Relationship of Obesity to


Asthma Impairment and Risk

Michael Schatz, MD, MSa, Robert S. Zeiger, MD, PhDa, Su-Jau Yang, PhDb, Wansu Chen, MSb,
Shiva Sajjan, PhDc, Felicia Allen-Ramey, PhDc, and Carlos A. Camargo, Jr, MD, DrPHd San
Diego and Los Angeles, Calif; West Point, Pa; and Boston, Mass

Presented by :
dr. Fifi Yuniarti
INTRODUCTION
Obesity is associated with increased asthma incidence, preva-
lence, and severity.
Although studies consistently show an association between obesity
and increased asthma incidence, the role of obesity in asthma
control is less clear.
Hypothese that baseline obesity would be associated with worse
future asthma control, in both the impairment and risk domains.
METHODS

● Objective
to evaluate the association between baseline body mass index (BMI)
and measures of subsequent asthma control in a large real-world cohort
of adults with persistent asthma.

● Method
Persistent asthma Patients In Kaiser Permanente Southern California (KPSC)in
2006 (Range age: 18-56), 10.233 patients continuous health plan enrollment in
2007 and 2008, and a BMI measurement in 2006 or 2007.

● Exclusion: BMI measure was not available in 2006 or 2007.


METHODS

● Outcome
Dispensing short-acting beta-agonist (SABA).
Emergency department visit and Hospitalization (EDHO) , oral corticosteroid
(OCS).

● Exposure variable and potential confounders


BMI obtained in 2006 or 2007 as normal (<25 kg/m2), over- weight (25-29.9
kg/m2), or obese ( 30 kg/m2).
METHODS

●Characteristic
1. Age
2. sex
3. asthma hospitalization or ED visit
4. OCS dispensing as defined above,
5. number of SABA canisters dispensing
6. cigarette smoking
7. gastroesophageal reflux disease (GERD)
8. depression
9. inhaled corticosteroid (ICS) (with or without long-acting beta-agonists)
METHODS

● Potensial confounder
(1) the proportion of the
population older than age 25 in the individual’s census block group
having more than a high school education
(2) the median household income in the individual’s census block group.
METHODS

●Data Analysis
relationships between BMI categories (and potential confounders) and asthma
control outcomes were evaluated by means of c2 analysis or one-way ANOVA.
Multivariable analyses were conducted by means of Poisson regression with
robust error variance, where BMI was a 3-level dependent variable (<25 kg/m2,
25-29.0 kg/m2, 30 kg/m2) with <25 kg/m2 as the reference group.
Risk ratios and 95% confidence intervals were reported.
Nominal 2-tailed statistical significance for all analyses was set at P < .05.
All analyses were conducted using SAS E.G. version 9.3
RESULT

• In the 10,233 eligible adults—after adjusting for potential


demographic, comorbidity, and prior utilization confounders
• An increased relative risk (RR) of EDHO in overweight and
obese (RR 1.40, 95% CI 1.10-1.78) individuals.
• Only obesity was associated in adjusted analyses with a
significant increased relative risk of SABA7 (RR 1.27, 95% CI
1.15-1.40).
DISCUSSION

relationship between overweight and obesity and asthma


exac- erbations remained significant
Moreover, obesity, but not GERD or depression, was
associated with SABA overuse in the current
DISCUSSION

● limitations
1. approximately 20% of our continuously enrolled patients with
persistent asthma did not have a BMI measurement, and our
results may not generalize to these patients.
2. findings may not be applicable to obese and overweight
asthmatic patients outside of the Kaiser Permanente health care
system.
3. our cohort had persistent asthma, and the current findings
may not generalize to patients with intermittent asthma.
DISCUSSION

this study showed that overweight and obesity increase the risk of
subsequent poor asthma control
CONCLUSION

 Elevated BMI, particularly obesity, is associated with


subsequent poor asthma control, especially in the risk domain
(exacerbations).
 These findings further support the importance of facilitating
weight loss in overweight and obese adults with asthma
THANK YOU

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