Prospective Study on the Relationship of Obesity to Asthma Impairment and Risk

Michael Schatz; Robert S Zeiger; Su-Jau Yang; Wansu Chen; Shiva Sajjan; Felicia Allen-Ramey; Carlos A Camargo Jr

doi:10.1016/j.jaip.2015.03.017

Prospective Study on the Relationship of Obesity to Asthma Impairment and Risk

J Allergy Clin Immunol Pract. 2015 Jul-Aug;3(4):560-5.e1. doi: 10.1016/j.jaip.2015.03.017. Epub 2015 May 11.

Authors

Michael Schatz¹, Robert S Zeiger², Su-Jau Yang³, Wansu Chen³, Shiva Sajjan⁴, Felicia Allen-Ramey⁴, Carlos A Camargo Jr⁵

Affiliations

¹ Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif. Electronic address: michael.x.schatz@kp.org.
² Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif.
³ Department of Research and Evaluation, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif.
⁴ Department of Global Health Outcomes, Merck & Co., Inc., West Point, Pa.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

PMID: 25975622
DOI: 10.1016/j.jaip.2015.03.017

Abstract

Background: Although studies consistently show an association between obesity and increased asthma incidence, the role of obesity in asthma control is less clear.

Objective: The objective of this study was 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.

Methods: In Kaiser Permanente Southern California (KPSC), a large managed care organization, we identified adults with persistent asthma in 2006, continuous health plan enrollment in 2007 and 2008, and a BMI measurement in 2006 or 2007. Each patient's last BMI measure in 2006 or 2007 was categorized into a BMI group: normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)), or obese (≥30 kg/m(2)). Asthma control outcomes in 2008 included asthma hospitalizations or emergency department visits (EDHO), oral corticosteroid dispensings linked to an asthma encounter (OCS), and dispensing of ≥7 short-acting beta-agonist canisters (SABA7). Multivariable analyses were conducted to assess the relationships of BMI categories with the risk of the asthma control outcomes after controlling for potential confounders.

Results: In the 10,233 eligible adults-after adjusting for potential demographic, comorbidity, and prior utilization confounders-we found 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).

Conclusions: 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.

Keywords: Asthma; Asthma control; Asthma exacerbations; Asthma impairment; Asthma risk; BMI; Obesity; Overweight; Short-acting beta-agonists.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adrenal Cortex Hormones / therapeutic use
Adrenergic beta-Agonists / therapeutic use
Adult
Asthma / drug therapy
Asthma / epidemiology*
Body Mass Index
Emergency Service, Hospital / statistics & numerical data
Female
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Overweight / epidemiology*
Prospective Studies
Risk
Young Adult

Substances

Adrenal Cortex Hormones
Adrenergic beta-Agonists